Kangaroo care as a potential infection prevention and control (IPC) measure in neonatal intensive care units

Background

Kangaroo care (KC) has been shown to be protective against hospital-acquired neonatal sepsis. One suggested mechanism includes the reduction in neonatal bacterial colonisation through skin-to-skin contact, as previously shown for Methicillin-Oxacillin-Resistant Staphylococcus, thus leading to fewer invasive bacterial infections.

Methods

The NeoIPC colonisation assessment is an EU Horizon 2020 funded multi-centre study characterizing bacterial colonisation in hospitalised neonates. KC practices were captured for each participating centre in a standardized questionnaire which included general and neonatal-specific IPC aspects. In addition, actual receipt of KC was collected in up to 4 colonisation surveys for each participant.

Results

By December 2022, 16 European NICUs had completed the IPC questionnaire. 11/16 (69%) units indicated offering KC, mainly to mothers and fathers. Overall median duration of a session was 105 min (IQR 60-165min). Barriers to KC indicated by the units were mostly surgery (8/11), mechanical ventilation (5/11) and carer known to be colonised with resistant bacteria (3/11). Written guidance and training were available in 7/11 units.

The colonisation assessment had 545 participants contributing to 1062 surveys. 307/545 (56%) received KC at some point during their hospitalisation up to the last survey they were included in. Overall in 1062 surveys, 510 participants (48%) had received KC in the 24 hours prior to the survey, these rates were similar in neonates < 32 weeks and >=32 weeks. Most common reasons for not receiving KC included presence of central lines, mechanic ventilation and staff or carers not being available.

Conclusion

While KC is potentially an effective neonatal specific IPC intervention, the results indicate that real-world implementation of KC varies strongly across European NICUs thus offering the potential to optimise this technique as an IPC strategy.