title: Implementation of evidence-based potentially better practices to decrease nosocomial infections.
abstract: 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. Nosocomial infection is a significant area for improvement in most NICUs.
  
  
  METHODS
  Six NICUs participating in the Vermont Oxford Network made clinical changes to address 3 areas of consensus: handwashing, line management, and accuracy of diagnosis. The summary statements were widely communicated. Review of the literature, internal assessments, and benchmarking visits all contributed to ideas for change.
  
  
  RESULTS
  The principle outcome was the incidence of coagulase-negative staphylococcus bacteremia. There was an observed reduction from 24.6% in 1997 to 16.4% in 2000.
  
  
  CONCLUSIONS
  The collaborative process for clinical quality improvement can result in effective practice changes.
authors.affiliation: Children's Mercy Hospitals and Clinics, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri 64108, USA. hkilbride@cmh.edu
authors.forename: Howard W
authors.initials: HW
authors.lastname: Kilbride
authors.forename: David D
authors.initials: DD
authors.lastname: Wirtschafter
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Powers
authors.forename: Michael B
authors.initials: MB
authors.lastname: Sheehan
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control*; D019985:Benchmarking; D002408:Catheters, Indwelling / Q000592:standards; D003299:Cooperative Behavior; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006235:Hand Disinfection / Q000592:standards; D006284:Health Plan Implementation / Q000379:methods; D006801:Humans; D015994:Incidence; 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; D017063:Outcome Assessment, Health Care; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control; D017749:Total Quality Management / Q000379:methods; D014481:United States