Effect of nursing procedures on mortality due to infection in low birth weight babies.

The most significant factor in the survival of low birth weight infants is the standard of nursing care provided. The objective of this study was to quantify the infection rate and the quality of nursing care as well as to observe the change concomittent with modifications in nursing techniques. The change in infection rate was considered an indicator of the effect of various nursing procedures on mortality due to infection in low birth weight infants. The study was undertaken in the nursery of Medical College Hospital Awangabad India where babies born in the hospital and weighing 2000 grams or less are admitted. The study was carried out in 2 phases each of 1 year duration. The host factors studied were birth weight sex Agpar score birth order and mode of delivery. 4 common but important nursing procedures identified for observation were: 1) routine nursing care in the ward by nursing staff; 2) artificial and breastfeeding of the babies; 3) changing of soiled diapers of the babies; and 4) general cleaning of the ward by servants under nurses supervision. A detailed stepwise format of these procedures was worked out after referring to the books. Each step was considered a point and each deviation a fault. Observation of the procedures was scheduled daily for 2 hours selected at random. Intensive training on nursing of premature babies was given in the 2nd phase of the study. There was month to month variation in mortality as well as in the infection rate but the variation was similar in both phases. Mortality due to infection in 1 year was 22.4% of the total outcomes. Some faults were observed in 29.9% of the nursing procedure steps during the same year. In the subsequent year the faults were reduced to 11.4% as a result of the specific training. Faults by mothers of the neonates and by ward-servants continued even after training of the nursing personnel. Mortality due to infection in the 2nd year was 26.8%. This study indicates that improvement in nursing care did not reduce mortality due to infection. Other aspects like change in the attitude of other personnel and use of chemical disinfectants need consideration.