Sustained reduction in neonatal nosocomial infections through quality improvement efforts

• Published in: Pediatrics (Evanston) 2012-01, Vol.129 (1), p.e165-e173
• Main Authors: Payne, Nathaniel R, Barry, Jennifer, Berg, Wendy, Brasel, David E, Hagen, Erik A, Matthews, Debra, McCullough, Kristin, Sanger, Katherine, Steger, Melissa D
• Format: Article
• Language: English
• Subjects: Antibiotics; Babies; Birth weight; Bronchopulmonary dysplasia; Care and treatment; Catheter-Related Infections - prevention & control; Control; Cross infection; Cross Infection - etiology; Cross Infection - prevention & control; Dosage and administration; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - prevention & control; Infant, Very Low Birth Weight; Infants (Premature); Intensive Care Units, Neonatal; Neonatal care; Nosocomial infections; Pediatrics; Premature infants; Quality Improvement
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2011-0566

Although reports of reduced nosocomial infections (NI) in very low birth weight infants have been published, the durability of these gains and changes in secondary outcomes, and clinical practices have less often been published. This was a retrospective, observational study of NI reduction in very low birth weight infants at two hospital campuses. The intervention began in 2005 with our renewed quality improvement efforts to reduce NI. We compared outcomes before (2000-2005) and after (2006-2009) the intervention by using univariate and multiple regression analyses. We reduced NI by 50% comparing 2000-2005 to 2006-2009 (23.6% vs 11.6%, P < .001). Adjusting for covariates, the odds ratio for NI was 0.33 (confidence interval, 0.26 - 0.42, P < .001) in the more recent era. NI were lower even in infants with birth weight 501-1000 grams (odds ratio = 0.38, confidence interval, 0.29 - 0.51, P < .001). We also reduced bronchopulmonary dysplasia (30.2% vs 25.5%, P = .001), median days to regain birth weight (9 vs 8, P = .04), percutaneously placed central venous catheter use (54.8% vs 43.9%, P = .002), median antibiotic days (8 vs 6, P = .003), median total central line days (16 vs 15, P = .01), and median ventilator days (7 vs 5, P = .01). We sustained improvements for three years. Quality improvement efforts were associated with sustained reductions in NI, bronchopulmonary dysplasia, antibiotic use, central line use, and ventilator days.