A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections

Wirtschafter, David D.; Pettit, Janet; Kurtin, Paul S.; Dalsey, Marian; Chance, Kathy; Morrow, Hallie; Seid, Michael; Byczkowski, Terri; Huber, Tanja; Milstein, Jay M.; Bowles, Susan M.; Fichera, Sharon; Kloman, S.

doi:10.1038/jp.2009.172

Cited by 90 publications

(64 citation statements)

References 21 publications

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“…Neonatal guidelines affect process but only inconsistently affect outcomes. 54 In contrast, targeted neonatal collaboratives have consistently affected their targeted outcomes (age at surfactant administration 38,54 and nosocomial infection or centralline-associated bloodstream infection reduction). 38,39,56,57 Our study shows a positive effect on the outcome of interest, although we did not have access to corroborating process data and made no specific plans for follow-up.…”

Section: Discussionmentioning

confidence: 99%

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

Wirtschafter¹,

et al. 2011

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WHAT'S KNOWN ON THIS SUBJECT: Quality-improvement techniques are increasingly effective as they move from passive dissemination to interactive techniques between those authoring practice change packages and their audiences. However, resource constraints and the many potential topics mitigate against prescribing intense collaboratives for every topic. WHAT THIS STUDY ADDS:Efficient progress in decreasing neonatal nosocomial infection rates can be achieved when statewide quality-improvement collaboratives using structured interventions ("toolkits") are augmented with brief interactions that introduce, orient, and motivate potential users. abstract OBJECTIVE: To evaluate the effectiveness of the California Perinatal Quality Care Collaborative quality-improvement model using a toolkit supplemented by workshops and Web casts in decreasing nosocomial infections in very low birth weight infants. DESIGN: This was a retrospective cohort study of continuous California Perinatal Quality Care Collaborative members' data during the years 2002-2006. The primary dependent variable was nosocomial infection, defined as a late bacterial or coagulase-negative staphylococcal infection diagnosed after the age of 3 days by positive blood/ cerebro-spinal fluid culture(s) and clinical criteria. The primary independent variable of interest was voluntary attendance at the toolkit's introductory event, a direct indicator that at least 1 member of an NICU team had been personally exposed to the toolkit's features rather than being only notified of its availability. The intervention's effects were assessed using a multivariable logistic regression model that risk adjusted for selected demographic and clinical factors. RESULTS: During the study period, 7733 eligible very low birth weight infants were born in 27 quality-improvement participant hospitals and 4512 very low birth weight infants were born in 27 non-qualityimprovement participant hospitals. For the entire cohort, the rate of nosocomial infection decreased from 16.9% in 2002 to 14.5% in 2006. For infants admitted to NICUs participating in at least 1 qualityimprovement event, there was an associated decreased risk of nosocomial infection (odds ratio: 0.81 [95% confidence interval: 0.68 -0.96]) compared with those admitted to nonparticipating hospitals. CONCLUSIONS: The structured intervention approach to quality improvement in the NICU setting, using a toolkit along with attendance at a workshop and/or Web cast, is an effective means by which to improve care outcomes.

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Section: Discussionmentioning

confidence: 99%

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

Wirtschafter¹,

et al. 2011

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“…The mean (center line) and upper and lower control limits were calculated and displayed as ±3 SD of the mean by using QI Macros for Excel (KnowWare International, Inc, Denver, CO). 30,31 …”

Section: Discussionmentioning

confidence: 99%

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

Ellsbury¹,

Clark²,

Ursprung³

et al. 2016

Pediatrics

115

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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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“…8 The variable success in QI initiatives to reduce CLABSIs and nosocomial infection in PICUs and NICUs highlights the challenges of developing best collaborative structures, supporting multidisciplinary hospital team formation, identifying best line care bundles, and tracking compliance with those bundles. [10][11][12][13][14] State collaboratives have gained increasing prominence in efforts to improve neonatal care and offer tremendous advantages as quality laboratories. 15 Collaboratives offer the opportunity for shared learning.…”

Section: Introductionmentioning

confidence: 99%

Reducing Central Line–Associated Bloodstream Infections in North Carolina NICUs

Fisher

Cochran

Provost³

et al. 2013

Pediatrics

101

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OBJECTIVE: Central lines in NICUs have long dwell times. Success in reducing central line-associated bloodstream infections (CLABSIs) requires a multidisciplinary team approach to line maintenance and insertion. The Perinatal Quality Collaborative of North Carolina (PQCNC) CLABSI project supported the development of NICU teams including parents, the implementation of an action plan with unique bundle elements and a rigorous reporting schedule. The goal was to reduce CLABSI rates by 75%. METHODS:Thirteen NICUs participated in an initiative developed over 3 months and deployed over 9 months. Teams participated in monthly webinars and quarterly face-to-face learning sessions. NICUs reported on bundle compliance and National Health Surveillance Network infection rates at baseline, during the intervention, and 3 and 12 months after the intervention. Process and outcome indicators were analyzed using statistical process control methods (SPC). RESULTS:Near-daily maintenance observations were requested for all lines with a 68% response rate. SPC analysis revealed a trend to an increase in bundle compliance. We also report significant adoption of a new maintenance bundle element, central line removal when enteral feedings reached 120 ml/kg per day. The PQCNC CLABSI rate decreased 71%, from 3.94 infections per 1000 line days to 1.16 infections per 1000 line days with sustainment 1 year later (P 5 .01). CONCLUSIONS:A collaborative structure targeting team development, family partnership, unique bundle elements and strict reporting on line care produced the largest reduction in CLABSI rates for any multiinstitutional NICU collaborative.

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A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections

Cited by 90 publications

References 21 publications

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

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

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

Reducing Central Line–Associated Bloodstream Infections in North Carolina NICUs

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