Effect of Enteral Feeding Tube Maintenance on Hospital Acquired Blood Stream Infections
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Background: Enteral feeding tubes are reservoirs for bacterial contamination leading to nosocomial infections, a type of hospital-acquired infection including central line associated blood stream infections (CLABSIs) and necrotizing enterocolitis (NEC), an infection located in the gastrointestinal tract. Neonatal patients are particularly at risk due to their immunosuppression, low birth weight and underdevelopment, especially of the gastrointestinal tract. Problem: Currently at a Midwestern children’s hospital an increase in central line associated blood stream infections continue to be problematic in the neonatal population. These issues persist despite the interventions, nursing care bundles, and auditing practices. A diagnosis of a CLABSI, causes an associated morbidity and mortality. Purpose: The purpose of this project was to examine NEC and CLABSI occurrences before and after the implementation of an enteral feeding tube care bundle. The setting occurred in a surgical NICU at a Midwest children’s hospital. Methods: A retrospective study was conducted in a level IV surgical NICU Midwestern children’s hospital. It was centered around an enteral feeding tube maintenance bundle and the effects it has on CLABSI and NEC rates. This bundle consisted of implementation of best practices for enteral feeding protocols which consisted of aseptic technique upon tube insertion and manipulation, weekly feeding tube change and aseptic technique while handling and preparing medication and formula. Patients with an indwelling feeding catheter were included in this project. Limitations included patients whom had surgically placed enteral catheters or nasojejunal tubes that were placed by fluoroscopy or x-ray and patients that had a primary diagnosis of NEC upon admission. Results: Prior to initiation of the enteral feeding bundle the CLABSI rate in 2015 was 3.1 infections per 1000 central line days, the rate fell to 0.2 infections per 1000 line days in 2016. Prior to implementation of the enteral feeding tube bundle a total of 15 patients out of 398 patients developed NEC during their hospitalization in the year of 2015 for a rate of 3.76 per 100 patients. Following the implementation of the enteral feeding tube bundle, there were a total of 10 patients out of 454 admitted patients that developed stage II NEC, for a rate of 2.2 per 100 patients. Conclusion: NEC rates did fall following implementation but evaluation over the next year is needed to correlate these results to implementation of the bundle. Even though there is no direct link from oral feedings to IV sites, the access to bacteria via the stomach and intestine can lead to infection and/or NEC. The change in central line infection (CLABSI) rates may not be due to the enteral feeding tube bundle, but may be due to increased vigilance on the maintenance of our central lines. Using sterile techniques for insertion of feeding tubes and clean care of these tubes may be related, and hopefully show a sustained drop in the CLABSI rate.