A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections.
OBJECTIVE
The objective of this study was to reduce central line-associated blood stream infections (CLABSIs) among 13 collaborating regional neonatal intensive care units by 25%. We tested the hypothesis that change could be attributed to the quality improvement collaborative by testing for 'special cause' variation.


METHODS
Our prevention project included five features: (1) leadership commitment, (2) potentially best practices, (3) collaborative processes, (4) audit and feedback tools and (5) quality improvement techniques. Baseline (1 January 2006 to 30 August 2006) data were compared with the intervention (1 September 2006 to 30 June 2007) and post-intervention (1 July 2007 to 30 December 2007) periods and analyzed using statistical process control (SPC) methods.


RESULTS
We detected special cause variation, suggesting that the collaborative was associated with reduced infection rates, from 4.32 to 3.22 per 1000 line days (a 25% decrease) when comparing the baseline with the follow-up period.


CONCLUSIONS
The collaborative's process was associated with fewer infections. SPC suggested that systematic changes occurred. The remaining challenges include sustaining or even further reducing the infection rate.
Wirtschafter
D D
DD
David D Wirtschafter, MD, Inc., Valley Village, CA, USA. david.wirtschafter@juno.com
Pettit
J
J
Kurtin
P
P
Dalsey
M
M
Chance
K
K
Morrow
H W
HW
Seid
M
M
Byczkowski
T L
TL
Huber
T P
TP
Milstein
J M
JM
Bowles
S M
SM
Fichera
S
S
Kloman
S
S
D016470:Bacteremia / Q000517:prevention & control*; D002140:California; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000592:standards*; D003428:Cross Infection / Q000517:prevention & control*; D006235:Hand Disinfection / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000379:methods*