Nosocomial Infection Reduction in VLBW Infants With a Statewide Quality-Improvement Model

Wirtschafter, David D.; Powers, Richard J.; Pettit, Janet S; Lee, Henry; Boscardin, W. John; Subeh, Mohammad; Gould, Jeffrey B.

doi:10.1542/peds.2010-1449

Cited by 100 publications

(81 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For critically ill neonates, incidence rates of CLABSI decreased by 4% per quarter (61% decline during the study period), whereas incidence rates of VAP declined by 3% per quarter (50% decline during the study period), representing sustained improvement for this vulnerable population. These findings are similar to reported decreases in CLABSI for neonates in state [23][24][25][26] and multistate collaborations. 27 Similar to previous studies, 1,20 we found that very low birth weight (VLBW) infants were more likely to have CLABSI or VAP than normal birth weight infants.…”

Section: Discussionsupporting

confidence: 89%

Health Care-Associated Infections Among Critically Ill Children in the US, 2007–2012

Patrick¹,

Kawai

Kleinman

et al. 2014

Pediatrics

View full text Add to dashboard Cite

BACKGROUND: Health care–associated infections (HAIs) are harmful and costly and can result in substantial morbidity for hospitalized children; however, little is known about national trends in HAIs in neonatal and pediatric populations. Our objective was to determine the incidence of HAIs among a large sample of hospitals in the United States caring for critically ill children from 2007 to 2012. METHODS: In this cohort study, we included NICUs and PICUs located in hospitals reporting data to the Centers for Disease Control and Prevention’s National Healthcare Safety Network for central line–associated bloodstream infections (CLABSIs), ventilator-associated pneumonias, and catheter-associated urinary tract infections. We used a time-series design to evaluate changes in HAI rates. RESULTS: A total of 173 US hospitals provided data from NICUs, and 64 provided data from PICUs. From 2007 to 2012, rates of CLABSIs decreased in NICUs from 4.9 to 1.5 per 1000 central-line days (incidence rate ratio (IRR) per quarter = 0.96, 95% confidence interval 0.94–0.97) and in PICUs from 4.7 to 1.0 per 1000 central-line days (IRR per quarter = 0.96 [0.94–0.98]). Rates of ventilator-associated pneumonias decreased in NICUs from 1.6 to 0.6 per 1000 ventilator days (IRR per quarter = 0.97 [0.93–0.99]) and PICUs from 1.9 to 0.7 per 1000 ventilator-days (IRR per quarter = 0.95 [0.92–0.98]). Rates of catheter-associated urinary tract infections did not change significantly in PICUs. CONCLUSIONS: Between 2007 and 2012 there were substantial reductions in HAIs among hospitalized neonates and children.

show abstract

Section: Discussionsupporting

confidence: 89%

Health Care-Associated Infections Among Critically Ill Children in the US, 2007–2012

Patrick¹,

Kawai

Kleinman

et al. 2014

Pediatrics

View full text Add to dashboard Cite

show abstract

“…Prevention of central line associated bloodstream infection (CLABSI) and other hospital-acquired infection in the NICU has been a recent target of quality improvement efforts. [5][6][7] Such efforts share the broader strategic objective of reducing health care misuse (1 of 3 categories of quality problems, along with underuse and overuse). 8 In 2012, more than 60% of NICUs in California reported a CLABSI rate of zero.…”

mentioning

confidence: 99%

Neonatal Intensive Care Unit Antibiotic Use

et al. 2015

Self Cite

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES: Treatment of suspected infection is a mainstay of the daily work in the NICU. We hypothesized that NICU antibiotic prescribing practice variation correlates with rates of proven infection, necrotizing enterocolitis (NEC), mortality, inborn admission, and with NICU surgical volume and average length of stay. METHODS:In a retrospective cohort study of 52 061 infants in 127 NICUs across California during 2013, we compared sample means and explored linear and nonparametric correlations, stratified by NICU level of care and lowest/highest antibiotic use rate quartiles.RESULTS: Overall antibiotic use varied 40-fold, from 2.4% to 97.1% of patient-days; median = 24.5%. At all levels of care, it was independent of proven infection, NEC, surgical volume, or mortality. Fifty percent of intermediate level NICUs were in the highest antibiotic use quartile, yet most of these units reported infection rates of zero. Regional NICUs in the highest antibiotic quartile reported inborn admission rate 218% higher (0.24 vs 0.11, P = .03), and length of stay 35% longer (90.2 days vs 66.9 days, P = .03) than regional NICUs in the lowest quartile.CONCLUSIONS: Forty-fold variation in NICU antibiotic prescribing practice across 127 NICUs with similar burdens of proven infection, NEC, surgical volume, and mortality indicates that a considerable portion of antibiotic use lacks clear warrant; in some NICUs, antibiotics are overused. Additional study is needed to establish appropriate use ranges and elucidate the determinants and directionality of relationships between antibiotic and other resource use.

show abstract

“…[2][3][4][5][6] Adopting evidence-based changes has been enhanced by participation in collaborative quality improvement (QI) projects, where changes are bundled together and implemented by teams from different centers sharing common strategies. 7,8 Collaborative QI, based on the Institute for Healthcare Improvement' s (IHI) model, 9 has been successful in settings such as the California Perinatal Quality Care Collaborative (CPQCC). 6,[7][8][9][10] This model brings together teams from different institutions, providing structured learning with face-to-face meetings, Web-based discussions, electronic mailing lists, expert panel access, and unblinded outcome and process data display, with incremental learning through reporting of successes, barriers, and lessons learned.…”

mentioning

confidence: 99%

Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study

Lee¹,

Powers

Bennett³

et al. 2014

PEDIATRICS

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT: Quality improvement (QI) studies generally do not account for concurrent trends of improvement and it is difficult to distinguish the impact of a multihospital collaborative QI project without a contemporary control group. WHAT THIS STUDY ADDS:A multihospital collaborative QI model led to greater declines in hypothermia and invasive ventilation rates in the delivery room compared with an individual NICU QI model and NICUs that did not participate in formal QI activities. abstract BACKGROUND: There is little evidence to compare the effectiveness of large collaborative quality improvement versus individual local projects. METHODS:This was a prospective pre-post intervention study of neonatal resuscitation practice, comparing 3 groups of nonrandomized hospitals in the California Perinatal Quality Care Collaborative: (1) collaborative, hospitals working together through face-to-face meetings, webcasts, electronic mailing list, and data sharing; (2) individual, hospitals working independently; and (3) nonparticipant hospitals. The collaborative and individual arms participated in improvement activities, focusing on reducing hypothermia and invasive ventilatory support.RESULTS: There were 20 collaborative, 31 individual, and 44 nonparticipant hospitals caring for 12 528 eligible infants. Each group had reduced hypothermia from baseline to postintervention. The collaborative group had the most significant decrease in hypothermia, from 39% to 21%, compared with individual hospital efforts of 38% to 33%, and nonparticipants of 42% to 34%. After risk adjustment, the collaborative group had twice the magnitude of decrease in rates of newborns with hypothermia compared with the other groups. Collaborative improvement also led to greater decreases in delivery room intubation (53% to 40%) and surfactant administration (37% to 20%). CONCLUSIONS:Collaborative efforts resulted in larger improvements in delivery room outcomes and processes than individual efforts or nonparticipation. These findings have implications for planning quality improvement projects for implementation of evidence-based practices.

show abstract

Nosocomial Infection Reduction in VLBW Infants With a Statewide Quality-Improvement Model

Cited by 100 publications

References 46 publications

Health Care-Associated Infections Among Critically Ill Children in the US, 2007–2012

Health Care-Associated Infections Among Critically Ill Children in the US, 2007–2012

Neonatal Intensive Care Unit Antibiotic Use

Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study

Contact Info

Product

Resources

About