A study of  Interventions and their  Impact on Sepsis Prevention at NICU

Sarath Kumar1, K. Senthil Kumar2

1Registrar, Department of Neonatology, Maa Kauvery, Trichy

2HOD, Department of Neonatology, Maa Kauvery, Trichy

Abstract

In spite of following necessary aseptic precautions, there was a rampant increase in sepsis positivity rate for highly virulent and unusual organisms, leading to rapid decline and deterioration that warranted frequent use of higher antibiotics and frequent stepping up of antibiotics, like First line, Second line, Third line.

Objectives

Implementing simple, scientific, yet cost effective and easily replicable methods using the available resources to

  • Reduce the culture positive sepsis rate.
  • To reduce the use of higher antibiotics.
  • Prevent the frequent stepping up of antibiotics.

Study Period

October 2024 to February 2025

Materials and methods

  • 24 hr video Surveillance
  • Hand hygiene
  • IV fluid preparation and administration
  • IV antibiotics preparation and administration
  • Blood Sampling
  • Securing IV line
  • UVC Procedures
  • Intubation and Suction procedures

Analysing and measuring the quality of care

Developing and Testing

  • 24hr hours video surveillance. Focused and individualised.
  • 2-person IV fluid preparation and administration
  • 2-person IV antibiotics preparation and administration
  • 3 way stop cock
  • Strict adherence of protocols during handling of IV line.

Changes implemented

BeforeAfter
Generalized surveillanceFocused surveillance
Single person loading IV fluids2 persons loading and giving IV fluids
Single person giving IV antibiotics2 persons loading and giving IV antibiotics
3 way stop cock not usedRoutine usage of 3 way stop cock

Process indicators

Deviations in

  • IV fluid preparation and administration
  • IV antibiotics preparation and administration
  • Blood Sampling
  • Securing IV line

Results and Outcomes

Deviations noted during focused video surveillance

Outcome indicators

  • Reduction in the culture positive sepsis rate.
  • Reduction in the use of higher antibiotics.

Reduction of culture positive sepsis:

Reduction in the usage of higher antibiotics

AntibioticsOctober 2024November 2024December 2024January 2025February 2025
Netilmicin/Ampicillin42.3% (66)62.6% (62)35.7% (39)44.4% (44)57.5% (61)
Meropenem/Vancomycin18.5% (29)15.8% (17)15% (17)18% (18)18% (20)
Colistin5.1% (8)4.1% (4)2.6% (3)-0.9% (1)
Ceftazidime-Avibactam with Aztreonam2.5% (4)1% (1)---
Linezolid1.9% (3)1% (1)0.9% (1)-0.9% (1)
Tigecycline-1% (1)--0.9% (1)

Conclusion

To achieve a sustainable growth, the following things, have to be followed,

  • Creating a system
  • Fixing responsibility and accountability
  • Encouraging
  • Empowering
  • Reporting
  • Reviewing.

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