Restriction of Central Line Insertion and Prophylactic Antibiotics Usage in Moderate and Late Preterm Infants from a Quality Improvement Perspective

Abstract

Objective: The care provided to moderate and late preterm (MLPT) infants is an area of significant practice variation and most of the quality improvement initiations are for very low birth weight infants. The objective of this study was to analyze hospital outcome changes in MLPT infants with central line insertion and prophylactic antibiotics usage restriction as a quality improvement method. Methods: This was a retrospective cohort study for MLPT infants who were admitted at Kangwon National University Hospital neonatal intensive care unit during 2013-2016. The groups were divided into period I (from 2013 to 2014) and period II (from 2015 to 2016) based on the changes in clinical practices. Since period II, feeding protocol was changed to rapid full-feeding and central line insertion practice was restricted to cases with feeding intolerance over 3 days of life. Prophylactic antibiotics were restricted to ampicillin with gentamycin except for special cases and indications were restricted depending on maternal factors plus clinical symptoms after birth. Results: Gestational age was lower and respiratory distress syndrome was frequent at period II. Central line insertion was reduced from period I to II (83% [147/177] vs. 36% [75/207]). Antibiotics exposures were less at period II (584 vs. 206 days per 1,000 patient-days). Clinical sepsis and central line associated bloodstream infection was significantly decreased at period II. Conclusion: Quality improvement for reducing central line insertion and prophylactic antibiotics usage in MLPT infants may be effective to reduce the incidence of infection related complications, especially sepsis.