Evaluating the Effectiveness of an Existing Late Onset Sepsis Tool in a Culture-positive Patient Subgroup at a Level III Newborn Intensive Care Unit

Background: Late-onset sepsis is an overwhelming systemic response to a bacterial, viral, or fungal infection and a leading cause of neonatal morbidity and mortality. The Surviving Sepsis Campaign has recommended each unit have a systematic sepsis screening process. Implementing a screening approach may improve the recognition of sepsis by prioritizing the evaluation of patients with identified clinical abnormalities. The lack of a bedside infection screening tool has been identified as a potential quality improvement opportunity. Methods: The efficacy of an existing neonatal sepsis screening tool was evaluated in a culture-positive group of infants. The clinical and laboratory variables were retrospectively collected during the week of infection. The collected variables were analyzed using the screening tool to compare how many infants would have triggered a sepsis investigation before the actual time the workup occurred. The number and frequency of physiological signs present before and during infection were collected. Results: The retrospective chart review included fourteen patients diagnosed with a late infection in a single Level III Newborn Intensive Care Unit (NICU) from January 2017 through December 2020. The clinical abnormalities increased in number as the day of infection approached. Yet only 29% (n=4) of patients ever met the criteria defined by the sepsis screening tool. The most common physiological abnormalities present the day before infection were increased oxygen needs (n=12), tachypnea (n=10), and tachycardia (n=10). No laboratory values were available the day before identification of infection. The stringent laboratory criteria posed a limitation to the full utilization of the screening tool. Conclusions: The application of the sepsis screening tool did not help identify the risk of infection before the positive blood culture was collected. The sepsis screening tool helped identify common physiological abnormalities leading up to infection. The identified variables may be utilized to develop a unit-specific sepsis screening tool as a future quality improvement project. The application of the screening tool uncovered an opportunity to improve provider-nurse communication and documentation for earlier recognition of infection.