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Abstract
Background Late onset Infection (LOI, infection after day 3 of postnatal life) is associated with neurodevelopmental impairment, bronchopulmonary dysplasia (BPD) and death among VLBW infants. The incidence of LOI varies widely between neonatal units and the optimal strategy for reducing LOI is uncertain. We aimed to evaluate the effect of a quality improvement (QI) initiative designed to reduce LOI.
Setting Royal Infirmary of Edinburgh. Patients: all VLBW infants treated between July 2011 and December 2013 (n = 276). We implemented QI strategies that included but were not limited to: gloves for patient handling; avoidance of unnecessary movement of staff and objects into a baby’s space; promotion of early human milk feeds; skin antisepsis with chlorhexidine; peripheral and central line care bundles; and staff feedback. LOI and BPD were classified according to Vermont Oxford Network definitions: infection after day 3 of postnatal life and oxygen requirement at 36 weeks corrected gestation. Prevalence of LOI and BPD were recorded prospectively and analysed as 6 month rolling averages.
Results The rate of LOI reduced from 38% to 6%, attributable to reductions in all cause sepsis (Figure). Over the same time period the absolute risk reduction for BPD was 23%.
Conclusion QI initiatives can be implemented without extra resource and their effect size for reducing LOI can be large. The observed association between LOI and BPD focuses attention on infection and inflammation as a modifiable determinant of BPD.