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

• Published in: Pediatrics (Evanston) 2011-03, Vol.127 (3), p.419-426
• Main Authors: WIRTSCHAFTER, David D, POWERS, Richard J, PETTIT, Janet S, LEE, Henry C, BOSCARDIN, W. John, MOHAMMAD AHMAD SUBEH, GOULD, Jeffrey B
• Format: Article
• Language: English
• Subjects: Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Birth weight; Birth weight, Low; Blood-borne diseases; Bloodborne diseases; California - epidemiology; Cross infection; Cross Infection - epidemiology; Demographic aspects; Disease prevention; Female; General aspects; Human bacterial diseases; Human infectious diseases. Experimental studies and models; Humans; Incidence; Infant, Newborn; Infant, Premature, Diseases - epidemiology; Infant, Very Low Birth Weight; Infectious diseases; Intensive Care Units, Neonatal - standards; Low birth weight; Male; Maternal health services; Medical sciences; Newborn babies; Nosocomial infections; Pediatrics; Prevention; Quality Assurance, Health Care - methods; Quality Improvement; Quality management; Quality of care
• ISSN: 0031-4005; 1098-4275; 1098-4275
• DOI: 10.1542/peds.2010-1449

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. 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. 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-quality-improvement 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 quality-improvement 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. 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.