Drs Piazza, Pallotto, and Brozanski in collaboration provided leadership for the design and analytics of the collaborative; and drafted, reviewed, and revised the manuscript. Ms Zaniletti and Mr Provost provided data analytics and critically reviewed the manuscript. All authors participated in the design and management of the collaborative, approved the fi nal manuscript as submitted, and agreed to be accountable for all aspects of the work. DOI: 10.1542/peds.2014-3642Accepted for publication Sep 21, 2015 Address correspondence to Anthony J. Piazza, MD, Department of Pediatrics, Division of Neonatal Medicine, Emory School of Medicine, 2015 Uppergate Rd, Atlanta, GA 30322. E-mail: apiazza@ emory.edu PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).Health care-associated infections (HAIs) are a burden to patients and the health care system. It is estimated that up to 50% of HAIs are preventable. 1,2 In 2002, however, HAIs in US hospitals reportedly reached ∼1.7 million, with >33 000 HAIs among infants in high-risk nurseries. 3 Central line-associated bloodstream infections (CLABSIs) have the highest cost per HAI and contribute to significant morbidities, mortality, and length of stay in the adult, pediatric, and neonatal populations. [4][5][6] The overall direct annual cost of US HAIs ranges from $35.7 to $45 billion for inpatient hospital services. 7 Although the actual cost of CLABSIs varies, the attributable cost to care is up to $69 000 per event. [7][8][9][10][11] Despite the risks with their use, central venous catheters (CVCs) play an integral role in modern health care. 12 The need for CVCs is particularly important in children's hospital NICUs for patients who abstract OBJECTIVE: Reduce central line-associated bloodstream infection (CLABSI) rates 15% over 12 months in children's hospital NICUs. Use orchestrated testing as an approach to identify important CLABSI prevention practices. METHODS:Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for central line care. Four existing CLABSI prevention strategies (tubing change technique, hub care monitoring, central venous catheter access limitation, and central venous catheter removal monitoring) were identified for study. We compared the change in CLABSI rates from baseline throughout the study period in 17 participating centers. Using orchestrated testing, centers were then placed into 1 of 8 test groups to identify which prevention practices had the greatest impact on CLABSI reduction. RESULTS:CLABSI rates decreased by 19.28% from 1.333 to 1.076 per 1000 line-days. Six of the 8 test groups and 14 of the 17 centers had decreased infection rates; 16 of the 17 centers achieved >75% compliance with process measures. Hub scrub compliance monitoring, when used in combination with sterile tubing change, decreased CLABSI rates by 1.25 per 1000 line-days. CONCLUSIONS:This multicenter improvement collaborative achieved a decrease in CLABSI rates. Orchestrated testing identified infection prev...

Significant gaps in healthcare quality and outcomes can be reduced via quality improvement collaboratives (QICs), which improve care by leveraging data and experience from multiple organizations.The Children's Hospital Neonatal Consortium Collaborative Initiatives for Quality Improvement team developed an infrastructure for neonatal QICs. We describe the structure and components of an effective multi-institutional neonatal QIC that implemented the "SLUG Bug" project designed to reduce central line-associated bloodstream infections (CLABSIs).The operational infrastructure of SLUG Bug involved 17 tertiary care neonatal intensive care units with a goal to reduce CLABSI in high-risk neonates. Clinical Practice Recommendations were produced, and the Institute of Healthcare Improvement Breakthrough Series provided the framework for the collaborative. Process measures studied the effectiveness of the collaborative structure.CLABSI rates decreased by 20% during a 12-month study period. Compliance bundle reporting exceeded 80%. A QIC score of 2.5 or more ("improvement") was achieved by 94% of centers and a score 4 or more ("significant improvement") was achieved by 35%.Frequent interactive project meetings, well-defined project metrics, continual shared learning opportunities, and individual team coaching were key QIC success components. Through a coordinated approach and committed leadership, QICs can effectively implement change and improve the care of neonates with complex diagnoses and rare diseases.