An Evidence-Based Safe Sleep Program Is Associated With Less Infant Sleep-Related Deaths

Abstract

Background: Sudden unexpected infant death (SUID) is a leading cause of infant mortality in the United States. Hospitals have implemented infant safe sleep programs with varying measures and degrees of success, but few have demonstrated improvements in hospital-based and home safe sleep practices with nurse subject matter experts (SMEs) and community SUID prevention campaigns.

Aims: This project evaluated the impact of a state-wide, evidence-based infant safe sleep program for birthing hospitals using nurse SMEs and a community awareness campaign on nurse knowledge, safe sleep environments, and trends in infant sleep-related deaths.

Methods: Between 2016 and 2021, a pre- and post-test quality improvement intervention-based design was used to enroll hospitals and train and embed SMEs to educate peers, conduct practice surveillance and audits, and address practice deviations. A website housed comprehensive resources, and a large-scale community-based social and print media campaign on safe sleep practices occurred. Nurse and practice data from 12 hospitals that fully implemented the program were compared pre- and post-implementation. State-wide survey data for key safe sleep indicators reported by parents were compared from our 12 birthing hospitals to other facilities.

Results: Of trained nurses (N = 902), 83.4% reported making substantial or exceptional progress in being proactive in surveillance of safe sleep environments. Pre- and post-implementation environmental audits showed a significantly higher proportion of infants in safe sleep positions post-implementation (94.3%) than pre-implementation (89.6%) (p = 0.001). Statewide survey data from birth parents discharged from our program hospitals significantly outperformed those discharged from other state facilities. Multi-media campaigns resulted in over 1.4 million impressions on our website. Sleep-related deaths for infants born at four program hospitals dropped 16.1% from 31 in 2018 to 26 in 2021.

Linking evidence to action: A safe sleep program improved hospital-based nurses' knowledge and practice and birth parent's knowledge and behaviors, and it was associated with a decrease in infant sleep-related deaths.

Keywords: evidence‐based; infant safe sleep; infant sleep‐related deaths; maternal and child health; quality improvement; sudden infant death syndrome; sudden unexpected infant death.