Quality Improvement in Neonatal Care Through Enhanced Patient Safety and Clinical Risk Management: a Before-and-after Study About Neonatal Sepsis

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2024 Sep 4

PMID 39228806

Authors

Davide Ferorelli

Vito Maria Goffredo

Elena Graziano

Maurizio Mastrapasqua

Michele Telegrafo

Annachiara Vinci

Paolo Visci

Marcello Benevento

Fiorenza Zotti

Alessandra Foglianese

Raffaella Panza

Biagio Solarino

Alessandro DellErba

Nicola Laforgia

Affiliations

Soon will be listed here.

Abstract

Introduction: Neonatal sepsis, classified into early-onset and late-onset based on symptom timing, poses significant risks of morbidity and mortality, especially in low birth weight infants. Effective clinical risk management protocols are crucial in reducing these risks.

Methods: This before-and-after study evaluated the impact of a newly implemented clinical risk management protocol in the Neonatology and Neonatal Intensive Care Unit (NICU) at Policlinico Hospital-University of Bari. The study included 399 neonates over three years, comparing pre- and post-protocol outcomes. Data collection focused on maternal and neonatal demographics, infection rates, and hospital stay lengths. Statistical analysis included -tests, Wilcoxon-Mann-Whitney tests, and logistic regression models.

Results: The study found no significant differences in neonatal pathologies or demographics between pre- and post-protocol groups. However, post-protocol implementation showed a notable reduction in umbilical venous catheter (UVC) infections ( = 0.018) and improved hospital stay lengths. Blood and urine cultures did not show significant changes in microbial patterns post-protocol.

Discussion: The findings underscore the effectiveness of structured clinical risk management protocols in enhancing neonatal outcomes, particularly in reducing specific infection risks. Despite the study's limitations, including its observational nature and sample size, the results advocate for broader adoption and further research on these protocols in diverse healthcare settings. The positive outcomes highlight the importance of continuous clinical risk management efforts in high-risk neonatal environments.

References

Stavroudis T, Miller M, Lehmann C . Medication errors in neonates. Clin Perinatol. 2008; 35(1):141-61, ix. DOI: 10.1016/j.clp.2007.11.010. View

Mistri I, Badge A, Shahu S . Enhancing Patient Safety Culture in Hospitals. Cureus. 2024; 15(12):e51159. PMC: 10811440. DOI: 10.7759/cureus.51159. View

Li X, Ding X, Shi P, Zhu Y, Huang Y, Li Q . Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children's hospital, 2013 to 2017. Medicine (Baltimore). 2019; 98(12):e14686. PMC: 6709008. DOI: 10.1097/MD.0000000000014686. View

Goh S, Kan S, Bharadwaj S, Poon W . A review of umbilical venous catheter-related complications at a tertiary neonatal unit in Singapore. Singapore Med J. 2021; 62(1):29-33. PMC: 8027161. DOI: 10.11622/smedj.2019140. View

Shukla V, Carlo W . Review of the evidence for interventions to reduce perinatal mortality in low- and middle-income countries. Int J Pediatr Adolesc Med. 2020; 7(1):2-8. PMC: 7193071. DOI: 10.1016/j.ijpam.2020.02.004. View

Gurung R, Zaka N, Budhathoki S, Sunny A, Thapa J, Zhou H . Study protocol: Impact of quality improvement interventions on perinatal outcomes in health facilities-a systematic review. Syst Rev. 2019; 8(1):205. PMC: 6694558. DOI: 10.1186/s13643-019-1110-9. View

Bhat Y R, Lewis L, K E V . Bacterial isolates of early-onset neonatal sepsis and their antibiotic susceptibility pattern between 1998 and 2004: an audit from a center in India. Ital J Pediatr. 2011; 37:32. PMC: 3444145. DOI: 10.1186/1824-7288-37-32. View

Moftian N, Samad Soltani T, Mirnia K, Esfandiari A, Tabib M, Rezaei Hachesu P . Clinical Risk Factors for Early-Onset Sepsis in Neonates: An International Delphi Study. Iran J Med Sci. 2023; 48(1):57-69. PMC: 9843461. DOI: 10.30476/IJMS.2022.92284.2352. View

Scendoni R, Bury E, Ribeiro I, Cingolani M, Cameriere R, De Benedictis A . Leading Pathogens Involved in Co-Infection and Super-Infection with COVID-19: Forensic Medicine Considerations after a Systematic Review and Meta-Analysis. Pathogens. 2023; 12(5). PMC: 10222087. DOI: 10.3390/pathogens12050646. View

10.

Corso L, Buttera M, Candia F, Sforza F, Rossi K, Lugli L . Infectious Risks Related to Umbilical Venous Catheter Dwell Time and Its Replacement in Newborns: A Narrative Review of Current Evidence. Life (Basel). 2023; 13(1). PMC: 9863057. DOI: 10.3390/life13010123. View

11.

Chen I, Chiu N, Chi H, Hsu C, Chang J, Huang D . Changing of bloodstream infections in a medical center neonatal intensive care unit. J Microbiol Immunol Infect. 2015; 50(4):514-520. DOI: 10.1016/j.jmii.2015.08.023. View

12.

Kouni S, Tsolia M, Roilides E, Dimitriou G, Tsiodras S, Skoutelis A . Establishing nationally representative central line-associated bloodstream infection surveillance data for paediatric patients in Greece. J Hosp Infect. 2018; 101(1):53-59. DOI: 10.1016/j.jhin.2018.07.032. View

13.

Perumal N, Wang D, Darling A, Wang M, Liu E, Urassa W . Associations between Gestational Weight Gain Adequacy and Neonatal Outcomes in Tanzania. Ann Nutr Metab. 2022; 78(3):156-165. DOI: 10.1159/000522197. View

14.

Bouzidi H, Emirian A, Marty A, Chachaty E, Laplanche A, Gachot B . Differential time to positivity of central and peripheral blood cultures is inaccurate for the diagnosis of Staphylococcus aureus long-term catheter-related sepsis. J Hosp Infect. 2018; 99(2):192-199. DOI: 10.1016/j.jhin.2018.01.010. View

15.

Cuna A, Morowitz M, Ahmed I, Umar S, Sampath V . Dynamics of the preterm gut microbiome in health and disease. Am J Physiol Gastrointest Liver Physiol. 2021; 320(4):G411-G419. PMC: 8238167. DOI: 10.1152/ajpgi.00399.2020. View

16.

Glaser M, Hughes L, Jnah A, Newberry D . Neonatal Sepsis: A Review of Pathophysiology and Current Management Strategies. Adv Neonatal Care. 2020; 21(1):49-60. DOI: 10.1097/ANC.0000000000000769. View

17.

Coggins S, Glaser K . Updates in Late-Onset Sepsis: Risk Assessment, Therapy, and Outcomes. Neoreviews. 2022; 23(11):738-755. PMC: 9675597. DOI: 10.1542/neo.23-10-e738. View

18.

Rastogi S, Shah R, Perlman J, Bhutada A, Grossman S, Pagala M . Pattern of bacterial colonization in a new neonatal intensive care unit and its association with infections in infants. Am J Infect Control. 2012; 40(6):512-5. DOI: 10.1016/j.ajic.2012.02.016. View

19.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

20.

Annamalai A, Gupta V, Jain S, Datta P . Increasing Resistance to Reserve Antibiotics: The Experience of a Tertiary Level Neonatal Intensive Care Unit. J Trop Pediatr. 2020; 67(1). DOI: 10.1093/tropej/fmaa086. View