Prevention of nosocomial infection of neonates in the NICU
Nosocomial bloodstream infections play a big part in infections that affect the very premature low birth weight infants in the Neonatal Intensive Care Units which can cause morbidity and mortality. Numerous attempts have been made to prevent infections and the outcomes have gone both ways with mixed results. The rates have varied from unit to unit and research has been performed to distinguish if the models that are used in each unit have made a difference in the prevention of infection. The population of the NICU is vulnerable and the effects of infection can increase the length of stay and the cost of the hospitalization. Many efforts have been successful but some variances in the rates still exist.
Strategies have been attempted to be identified to minimize the risks of nosocomial infection in low-birth-weight infants (Newby, 2008, p. 421). In the NICU population the nosocomial infection rate is the highest in the VLBW (very low birth weight) infants. They are amongst the largest of the groups of infants that require more interventions and support procedures that come along. The smaller, less mature infants are more prone to infection since they have sensitive and immature skin that from any portal of entry, the higher infection rates are almost impossible to overcome. There are several factors to consider such as if the problem exists because of the prematurity of the infant or is it the effect of the environment or treatment given in the NICU.
Hospitalized neonates, who may have multiple invasive procedures, exposure to antimicrobial agents, and indwelling medical devices, are at high risk for nosocomial infection (Stokowski, RN, MS, 2008, ¶ 1). Efforts needed to reduce the rate of infection require the understanding of factors that can cause the occurrence of infection and act of changing the processes of care. In order for change to be successful an understanding of the care team of nosocomial infection beliefs and what their behaviors are need to be known and common. The purpose of the study is to lower infection rates and to determine if the staff, working together possesses the same concept of infection and prevention. Research question that is used during the research is to know what mental model is shared in association with the increase or decrease of NBSI rates in the NICU. Is a prevention model where nosocomial infection perceived as inevitable events when there is a decrease in infection rates in the NICU? What characteristics of the NICU sustain the prevailing mental model of NBSI? It is hypothesized that what the unit as a team perceives what is nosocomial infection, what it is and what are their reactions as a group and their behaviors (Luan, 2006, p. 29) The qualitative method of study was used to explore the concept of a shared mental model of NBSI within the NICU where the NICU is the unit of analysis. Data was collected from several different hospitals in the Vermont Oxford Network’s and site visits were conducted to collect data through interview and observations. Interviews were done with staff workers present at the time and willing to participate which included the physicians, nursing leadership roles, Nurse Practitioners, and staff nurses. The research design consisted of information that was gathered regarding risk factors, strategies to minimize risks involved, the collaboration of the team structure and how their response is to prevent infection and how to manage it. Procedures done were through observation and interviews. All information was categorized and consent for interviewing and protection of privacy of the participants was conducted. The staff and team were found to have a Prevention model instilled and the prevention rate could be as low as zero since infection is preventable. The incidence is seen as errors that have occurred in the process of care. The idea of infection is found to not be inevitable since the event of infection would be the result in complications of care. These findings would impact nursing care because infection prevention could be stressed in the unit and together as a team it could be prevented while following the same guidelines and practices while having the same beliefs. Clinical leaders could organize in-services and classes for further education. Research could be conducted in the future to continue to find ways to prevent infections that are almost foreseeable in this small population. The research studies were approved by an institutional review board and patient, staff privacy was protected as no names or hospitals were included in the research. Ethical considerations were taken in account regarding the treatment of care of the neonates involving nosocomial infection. The results of the study show that there are greater risks for the neonate who is smaller in size and gestational weeks that require more invasive treatment. There are a larger number of morbidities and mortalities associated with nosocomial infections that with the comparing of the units with higher infection rates to those of lower infection rates factors can be identified and reduction strategies could be put into place to be followed by all staff members. Practices that include a structured strategy could address those risks and the incidence of neonatal infection can be reduced (Newby, 2008)