Reducing Central Line–Associated Bloodstream Infections in North Carolina NICUs

Fisher, David G.; Cochran, Keith M.; Provost, Lloyd; Patterson, Jacquelyn; Bristol, Tara; Metzguer, Karen; Smith, Brian P.; Testoni, Daniela; McCaffrey, Martin J.

doi:10.1542/peds.2013-2000

Cited by 96 publications

(72 citation statements)

References 18 publications

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“…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

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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.

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Section: Discussionsupporting

confidence: 89%

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

Patrick¹,

Kawai

Kleinman

et al. 2014

Pediatrics

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“…4,5,7,8,14,33,34 The 100 000 Babies Campaign was unique in that it was successfully conducted within a large neonatal network with automated data collection, and improved multiple processes and outcomes simultaneously, rather than targeting a single process or morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…10 Emphasis was placed on identifying clinical processes that were modifiable and had substantial impact on the primary drivers of poor health outcomes 8,[11][12][13][14][15][16][17][18][19][20] (Fig 1). John Kotter's 8-step model for leading organizational change was used for the design and implementation of our campaign (Fig 2).…”

Section: Model Developmentmentioning

confidence: 99%

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign

Ellsbury¹,

Clark²,

Ursprung³

et al. 2016

Pediatrics

110

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BACKGROUND AND OBJECTIVE: Despite advances in neonatal medicine, infants requiring neonatal intensive care continue to experience substantial morbidity and mortality. The purpose of this initiative was to generate large-scale simultaneous improvements in multiple domains of care in a large neonatal network through a program called the “100,000 Babies Campaign.” METHODS: Key drivers of neonatal morbidity and mortality were identified. A system for retrospective morbidity and mortality review was used to identify problem areas for project prioritization. NICU system analysis and staff surveys were used to facilitate reengineering of NICU systems in 5 key driver areas. Electronic health record–based automated data collection and reporting were used. A quality improvement infrastructure using the Kotter organizational change model was developed to support the program. RESULTS: From 2007 to 2013, data on 422 877 infants, including a subset with birth weight of 501 to 1500 g (n = 58 555) were analyzed. Key driver processes (human milk feeding, medication use, ventilator days, admission temperature) all improved (P < .0001). Mortality, necrotizing enterocolitis, retinopathy of prematurity, bacteremia after 3 days of life, and catheter-associated infection decreased. Survival without significant morbidity (necrotizing enterocolitis, severe intraventricular hemorrhage, severe retinopathy of prematurity, oxygen use at 36 weeks’ gestation) improved. CONCLUSIONS: Implementation of a multifaceted quality improvement program that incorporated organizational change theory and automated electronic health record–based data collection and reporting program resulted in major simultaneous improvements in key neonatal processes and outcomes.

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“…The results revealed a 3.1% incidence of bloodstream infections associated with catheters, corresponding to 1.66/1,000 catheters/day. (15) The comparison of this finding is delicate due to the diversity of concepts and terminology used in the literature for referring to infection. A term used frequently is bloodstream infection related to the catheter.…”

Section: Discussionmentioning

confidence: 99%

Fatores de risco para infecção de corrente sanguínea associada ao cateter central de inserção periférica em neonatos

et al. 2016

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Objective: To identify the risk factors for bloodstream infection associated with peripherally inserted central catheters in neonates. Methods: A prospective cohort study conducted in the neonatal intensive care unit with newborns undergoing insertion of 401 peripherally inserted central catheters. Clinical characteristics of the newborn, catheter insertion technique, intravenous therapy and catheter dwell time were tested as risk factors for removal due to catheter associated bloodstream infection, using bivariate analysis and multivariate analysis with Poisson regression. Results: The data suggest that the lowest mean in weight and corrected gestational age, as well as the largest catheter dwell time time were associated with the occurrence of bloodstream infection associated with the catheters. The corrected gestational age, clinical diagnosis of transitional metabolic disorder or apnea, and the use of two-lumen catheters have been identified as risk factors. Conclusion: The lowest correct gestational age of the newborn, the clinical diagnosis of metabolic disorder or apnea, and the use of two-lumen catheters were identified as risk factors for bloodstream infection associated with peripherally inserted central catheters in neonates. ResumoObjetivo: Identificar os fatores de risco para infecção de corrente sanguínea associada ao cateter central de inserção periférica em neonatos. Métodos: Estudo de coorte prospectivo conduzido em unidade de terapia intensiva com recém-nascidos submetidos à instalação de 401 cateteres centrais de inserção periférica. Características clínicas do neonato, técnica de inserção do cateter, terapia intravenosa e tempo de permanência do cateter foram testados como fatores de risco para remoção por infecção de corrente sanguínea associada ao cateter, por meio de análise bivariada e análise multivariada com regressão de Poisson. Resultados: Os dados sugerem que as menores médias de peso e idade gestacional corrigida, bem como o maior tempo de permanência do cateter estiveram associados à ocorrência de infecção de corrente sanguínea associada ao cateter. A menor idade gestacional corrigida, os diagnósticos clínicos de transtorno transitório do metabolismo e apneia, e o uso do cateter de duas vias foram identificados como fatores de risco. Conclusão: A menor idade gestacional corrigida do neonato, os diagnósticos clínicos de transtorno transitório do metabolismo e apneia, e o uso do cateter de duas vias foram identificados como fatores de risco para infecção de corrente sanguínea associada ao cateter central de inserção periférica em neonatos.

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Reducing Central Line–Associated Bloodstream Infections in North Carolina NICUs

Cited by 96 publications

References 18 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

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign

Fatores de risco para infecção de corrente sanguínea associada ao cateter central de inserção periférica em neonatos

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