Evaluation and development of potentially better practices to prevent neonatal nosocomial bacteremia.
OBJECTIVE
Six neonatal intensive care units (NICUs) that are members of the Vermont Oxford National Evidence-Based Quality Improvement Collaborative for Neonatology collaborated to reduce infection rates. There were 7 centers in the original focus group, but 1 center left the collaborative after 1 year. The objective of this study was to develop strategies to decrease nosocomial infection rates in NICUs.


METHODS
The process included a comprehensive literature review, internal practice analyses, benchmark studies, and development of practical experience through rapid-cycle changes, subsequent analysis, and feedback. This process led to 3 summary statements on potentially better practices in handwashing, approach to nosocomial sepsis evaluations, and central venous catheter management.


RESULTS
These statements provide a basis for an evidence-based approach to lowering neonatal intensive care unit nosocomial infection rates.


CONCLUSIONS
The 2-year process also led to changes in the culture and habits of the institutions involved, which should in turn have long-term effects on other aspects of quality improvement.
Kilbride
Howard W
HW
Children's Mercy Hospitals and Clinics, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri 64108, USA. hkilbride@cmh.edu
Powers
Richard
R
Wirtschafter
David D
DD
Sheehan
Michael B
MB
Charsha
Dianne S
DS
LaCorte
Meena
M
Finer
Neil
N
Goldmann
Donald A
DA
D016470:Bacteremia / Q000517:prevention & control*; D019985:Benchmarking; D001800:Blood Specimen Collection / Q000592:standards; D003299:Cooperative Behavior; D003428:Cross Infection / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006235:Hand Disinfection / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration / Q000592:standards*; D015931:Intensive Care, Neonatal / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D009936:Organizational Innovation; D009937:Organizational Objectives; D016730:Program Development; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D017749:Total Quality Management / Q000379:methods; D014481:United States