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Preventing one of the Most Dangerous Infections in Newborns

An infant's hand wraps around a woman's finger.

Nursing student Robin Koeppel’s research examines how Neonatal Intensive Care Units can prevent blood stream infections stemming from central line catheters in newborns.

The Neonatal Intensive Care Unit (NICU) is a special nursery that provides care to very sick newborns. These newborns may be full-term facing a serious illness or, more commonly, premature newborns.

Unfortunately, infection often complicates the newborn’s course; premature newborns are at highest risk for infection due to their altered ability to fight infection. One of the most dangerous infections stems from the central line catheter; a medically needed catheter used to deliver nutrition and fluids directly into one of the body’s largest veins. Not only is treatment of central line-associated infections costly, the infection may add serious complications to the infant’s medical course and increase time spent in the NICU. In addition, up to 20 percent of these infections are fatal.

Avoiding infection is of primary importance and often involves changes to how providers (nurses, physicians, and others) care for the central line. For example, restructuring how medications are administered using the central line reduces the number of opportunities to introduce infection. Fortunately, over the past several years, NICU Quality Improvement (QI) programs across the nation have been successful in reducing the incidence of central line-associated infections.

Koeppel’s project reviews the effect of a QI project on central line infections and identifies key factors associated with sustained low infection rates in the NICU. Analyzing the QI project retrospectively, there was a steady decline in infections over the 11-year time period resulting in a 92 percent reduction when compared to the baseline period. This significant reduction in infections helps to reduce medical complications, time in the hospital, hospital costs, and deaths.

Dr. Joy Goebel (School of Nursing and Koeppel’s chair) states Koeppel identified four key factors associated with significant and sustained low infection rates over the 11-year project. Identification of these key factors adds to the newly evolving published literature investigating sustainment of improvement efforts and may assist other NICUs struggling with maintaining long-term success.

Koeppel reflected on her DNP project, “Reviewing and analyzing this QI project and identifying key sustainability factors has been a significant learning experience. As a result, I have changed my approach and design of current QI projects, focusing on integrating activities that support long-term sustainment.”

By focusing on sustainment factors, Koeppel’s project findings also contribute to the literature and serve as the basis for further research designed at evaluating long-term improvement success.

An example of a Central Line-Associated Bloodstream Infection communication:

An infant's feet next to a hand.


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