Improving Quality of Care Reduces Infection and Lung Distress in Premature Infants

New methods for improving quality of care in neonatal intensive care units (ICUs) could reduce hospital-acquired infections and chronic respiratory distress (with oxygen dependency) in premature infants, according to a new study.

Researchers from the University of Toronto (UT; ON, Canada), University of British Columbia (UBC; Vancouver, BC, Canada), and other institutions used cluster randomization to assign 6,519 infants in neonatal intensive care units (ICUs) to three groups; a nosocomial infection (infection) group, a bronchopulmonary dysplasia (pulmonary) group, and a control group. The researchers included all infants born at 32 or fewer weeks of gestation, and collected baseline data for one year. Working in multidisciplinary groups, six hospitals in Canada each developed a list of hospital-specific practice changes and priorities to implement in their neonatal ICU. Practice change interventions were implemented using rapid-change cycles for two years.

The results showed that after adopting practice-change strategies, the incidence of nosocomial infection decreased 32% and 45% in the first two groups. Respiratory distress in the pulmonary group decreased by 15%, and there was a 12% decrease in death from this condition. Based on pooled hospital data, the authors found that 40% of infections in neonatal ICUs were associated with central lines and central catheters inserted into organs; but when they looked at individual hospital data, they found that different patterns of infection were associated with the catheter insertions. The study was published in the August 10, 2009, issue of the Canadian Medical Association Journal (CMAJ).

"We found that interventions aimed at one outcome may affect other outcomes,” concluded lead author Shoo Lee, M.D., of the University of Toronto and colleagues.” We speculate that the decrease in the incidence of nosocomial infections in the pulmonary group was related to improved lung status and a reduced need for assisted respiration, invasive interventions, improved feeding and growth, and better overall health.”

In a related commentary in the same issue of CMAJ, William McGuire, M.D., of the Hull York Medical School (York, UK), reported that marked variation in practice contributed to uneven outcomes for premature infants, even when good evidence existed for specific interventions. He added that the study by Dr. Lee and colleagues adds to the accumulating evidence that multifaceted interventions may change practice and outcomes in neonatal ICU settings.

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