Browsing by Subject "Intensive Care Units, Neonatal"
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Item Changes in Rate of Methicillin-Resistant Staphylococcus Infection in a Community Neonatal Intensive Care Unit Before and During the COVID-19 Pandemic(2024-01-30) Blumenfeld, Abby; Hagans, Michelle; Chan, ChristinaBACKGROUND: Methicillin-Resistant Staphylococcus aureus (MRSA) infections represent a significant healthcare challenge, particularly in neonatal intensive care units (NICUs) where patients experience increased morbidity and mortality. MRSA transmission has not been well studied in the setting of enhanced infection precautions (EIP) taken during the COVID-19 pandemic - such as universal masking and enhanced hand hygiene. OBJECTIVE: This retrospective cohort study compared rates of MRSA infection in a community NICU during two distinct time periods: January 2016 to March 2020 (Pre-EIP: before EIP was instituted) and April 2020 to December 2022 (With-EIP: after EIP was instituted). METHODS: During the study period, 74 neonates admitted to the NICU tested positive for MRSA (56 Pre-EIP and 18 With-EIP). MRSA cases were collected using laboratory and electronic medical record review. Cases were reported as infections per 1,000 patient days (IP-1000). Statistical analysis with two-sample t-tests assuming unequal variance and chi squared tests for independence were performed. RESULTS: There was a significant decrease in MRSA IP-1000 from 1.90 Pre-EIP to 0.93 With-EIP (p=0.0006). The prevalence of MRSA clusters, defined as three infections within a 30-day period, decreased from 0.27 Pre-EIP compared to 0.03 With-EIP (p=0.0004). However, The Pre-EIP cohort had a younger average gestational age (30.2 vs 33.8 weeks, p=0.001), higher rates of very low birth weight (59% vs 28%, p=0.021), and fewer inborn neonates (88% vs 100%, p=0.115) - factors known to increase risk of MRSA infection. CONCLUSION: These findings suggest that EIP may have contributed to the reduction in MRSA clusters observed in this community NICU. Findings are limited by differences in cohort risk factors, small study population, variabilities in infection precautions throughout the pandemic, and the inherent bias of retrospective cohort analysis. This underscores the importance of prevention strategies and highlights the potential benefits of continued enhanced infection precautions in reducing the transmission of MRSA in vulnerable inpatient populations.Item Reducing CPAP Failure in Extremely Preterm Infants(2019-04-02) He, Henry; Reed, W. Gary; Kakkilaya, Venkatakrishna; Kapadia, VishalBACKGROUND: Extremely preterm infants (<29 weeks EGA) have high rates of respiratory distress syndrome (RDS). Continuous positive airway pressure (CPAP) ± intubation and surfactant administration provide a safe and effective way of treating RDS without the need for prophylactic intubation and surfactant administration. CPAP failure occurs when infants on CPAP must be subsequently intubated within the first 72 hours of life. LOCAL PROBLEM: The CPAP failure rate at Parkland Hospital is elevated compared to the gold standard neonatal ICU (NICU) at Columbia University. METHODS: Quality improvement tools were applied to assess areas for improvement in the CPAP process. The baseline rates of CPAP failure at the Parkland NICU were determined through chart review. Observation of the CPAP process and interviews with NICU staff was performed. INTERVENTIONS: A CPAP failure checklist was developed and placed in each NICU room. Quarterly training led by a respiratory therapist was provided to NICU staff. CPAP audits were updated, and a visual display of the proper CPAP setup was placed in each NICU pod. RESULTS: There was no significant change in the CPAP failure rate from 2015 to 2017. However, there was a reduction in the variation in the CPAP failure rate from 2015 to 2017. There was no change seen in the secondary outcome of the bronchopulmonary dysplasia rate but there was a significant decrease in the total ventilator days. During this time frame, there was also an increase in the number of infants arriving to the NICU on CPAP. CONCLUSION: Our interventions were not successful in lowering the CPAP failure rate. However, our interventions did have a measurable effect in lowering the variability of the failure rate. The decrease in the total ventilator days and increase in the number of infants being managed solely on CPAP indicates a culture shift in the NICU.Item Transitioning from Open Bay to Private Room: The Impact on Neonatal Parent-Staff Communication(2018-03-26) Hokanson, Jamila Cutliff; Frost, Mackenzie; Reed, W. Gary; Phelps, EleanorBACKGROUND: Effective parent-staff communication improves parents' emotional well-being, leads to better parent-infant bonding, and increases parental involvement in their child's care. Several studies address the impact of workflow and analyze the effectiveness of parent communication in a neonatal intensive care unit (NICU). However, few studies address parent-staff communication impact when moving from an open bay NICU to private rooms. OBJECTIVE: To determine the impact on neonatal parent-staff communication in moving from an open bay to a private room neonatal intensive care design. METHODS: Based on stakeholder interviews, spaghetti diagrams, and a communication process map, we developed and administered a mixed format parent and provider questionnaire to measure communication perception differences in the open bay and private room environment. RESULTS: There was no statistical difference (p-value > 0.05) between perceptions of communication in the open bay (2.33) versus the private room (2.34). However, there was a statistical difference (p-values < 0.05) between the providers' communication perception (2.16, 2.26) versus the parents' communication perception (2.88, 2.75). In addition, moving from an open bay to a private room environment widened the difference between the types of information parents desired versus what they actually received. Additional communication opportunities identified, in both the open bay and private room environment, include minimizing conflicting information, increasing parental engagement, and using diversified communication methods. CONCLUSIONS: Moving from an open bay to a private room NICU did not have a significant impact on parent-staff communication, but opportunity areas to improve parent-staff communication were identified. This data is being used to design interventions to improve parent-staff communication in our NICU.