Central line associated blood stream infections (CLABIs) are associated with an increase in length of stay, morbidity, hospital costs, and mortality. In 2009, CLABIs were on the increase at Covenant Healthcare's 55 bed Level III neonatal intensive care unit (NICU). Prior to this practice initiative, there were no standardized central line management practices in the NICU. We retrospectively reviewed the incidence CLABIs for the six months prior to the initiation of the standardization of central line management and then 3 months following the implementation of the new practice policy. Specific outcomes measured were the number of CLABIs, length of stay related to CLABIs, and adherence to the policies and procedures. The project was implemented in four phases: 1) hand hygiene, 2) "scrub the hub", 3) central line tubing changes, 4) central line insertion, removal, and dressing changes. Although there were no statistically significant changes in the outcome measures, there were clinically significant differences between length of stay and risk for central line infection, incidence of CLABIs, and an increase in adherence to the central line practice change policies. The study showed for every week that is added to the patient stay, the patient was 7 times more likely to have a CLABIs. The rate of central line infection was decreased from 15.6 percent per 1000 line days to zero in 2010.
Purpose:To evaluate the impact of nurse-regulated feedings (NRFs) on growth velocity and weight gain of 1200–1500 g preterm infants.Subjects:Cohort 1: All preterm infants 1200–1500 g between 1997 and 2001 not on NRF protocol; Cohort 2: All preterm infants 1200–1500 g between 2003 and 2006 on NRF protocol. Both cohorts screened out for small gestation age, major congenital anomalies, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), culture positive infection at birth, meningitis, and those requiring surgery.Materials and Methods:A before and after matched cohort study was conducted in the years 1997–2001 and 2003–2006, enrolling infants from Covenants Neonatal Intensive Care unit (Level III) using these studies screening protocol. Data on first 62 enrolling infants from both cohorts were used for this study. Both cohorts were matched using gestational age, birth weight, length of stay, initial length. A modified data tool collection set was used for collecting and analyzing nutritional data, this included intake (cal/kg/d, cc/kg/d, and total intake in cc) and route (initial parenteral feedings, mixed parenteral and enteral feedings, full enteral feedings), NRF, and non-NRF (NNRF). Data collection continued until discharge, initiation of adlib feeding, or greater than 50% of nutrition from breast.Discussion:Of the entire population sampled from 1997 to 2006, there were only 59 for NRF and 58 for NNRF. The mean growth velocity (g/kg/d) to reach full enteral feedings for both cohorts was insignificant (t=0.233; P=0.816). This suggested both groups were well matched up to the point of NRF institution for the 2003–2006 cohort years.Results:NRF had a 71% greater growth velocity than NNRF (P<0.001, t=6.618) at the time of discharge, initiation of adlib feeding, or greater than 50% of nutrition from breast.Conclusions:This study demonstrated that the NRF protocol offers a significant advantage in nutritional support than previous feeding regimens in this institution.
This article examines a quality-improvement project to reduce clinical practice variation and measure growth outcomes by standardizing the process for the provision of protein intake for premature infants weighing 1250 g or less. Eighteen infants with a birth weight of 1250 g or less and gestational age of 32 weeks or less born between June and October 2010 were compared with 15 historical controls of the same birth weight and gestation born between January and May 2010 using a prospective cohort design. The prospective group followed a newly implemented standardized protein nutritional guideline. Independent t-tests and repeated measures of analyses of variance (between- and within-subjects) were performed on the difference between the intended and actual protein intakes between the 2 groups. A multivariate analysis of variance computed the difference between the birth and discharge gains. The prospective group showed statistically significant differences between the amount of intended and actual protein intakes (P = .023) when compared with historical controls. Growth outcomes were not significantly different (P = .67) between the 2 groups. Length of stay was not statistically significantly shorter (P = .06) in the prospective group. Reduction in clinical practice variation was associated with the implementation of a protein nutritional guideline. There was no statistical support for an improvement in the growth outcomes or reduction in length of stay.
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