Using the KTA framework to improve evidence-based umbilical cord care for newborns in the NICU: a pre-post implementation study

ABSTRACT Introduction: Umbilical cord care constitutes a fundamental component of routine neonatal nursing. Authoritative guidelines on this practice date back to the 1980s, but these recommendations have remained unexplored in terms of clinical adoption. Objective: The primary objective was to identify the best available evidence regarding neonatal umbilical cord care in a neonatal intensive care unit (NICU) and evaluate its clinical effectiveness. Methods: A quality improvement project guided by the Knowledge-to-Action (KTA) framework was conducted in the NICU of a tertiary hospital in China. Evidence was identified through a systematic literature search and synthesized to generate evidence-based recommendations. The intervention was implemented using a pre-post control study design from November 2024 to April 2025. Results: This research revealed the safety of dry cord practice in China. Following implementation of the intervention, the nurses’ knowledge scores increased from 62.31 ± 8.70 to 90.78 ± 3.70, and their professional identity scores improved from 75.16 ± 5.90 to 84.11 ± 6.70 (both p < 0.001). Their compliance with most audit criteria improved significantly, ranging from 79.5% to 88.5%. The pain scores were significantly lower in the transformation group than in the baseline group ( p = 0.006). The arousal scores did not differ between groups pre-nursing ( p = 0.719) but were significantly lower in the transformation group post-nursing ( p = 0.003), indicating reduced care-related arousal in the transformation group. No statistically significant differences were observed in terms of omphalitis incidence or the cord separation time. Conclusions: The implementation of evidence-based umbilical cord care using the KTA framework improved nursing practice, enhanced neonatal comfort, and reduced care-related arousal without increasing adverse outcomes. Clinically, the implemented standardized operational procedure provides a practical and feasible strategy for integrating evidence into routine NICU care by optimizing workflow, supporting patient-centered care, and promoting consistent umbilical cord management in neonatal settings. Accordingly, this research advocates that scholarly attention focus on the profound effects of routine care innovations on neonatal medical ecosystems. Spanish abstract: https://links.lww.com/IJEBH/A666