title: Ohio statewide quality-improvement collaborative to reduce late-onset sepsis in preterm infants.
abstract: OBJECTIVE
  We aimed to reduce late-onset bacterial infections in infants born at 22 to 29 weeks' gestation by using collaborative quality-improvement methods to implement evidence-based catheter care. We hypothesized that these methods would result in a 50% reduction in nosocomial infection.
  
  
  METHODS
  We conducted an interrupted time-series study among 24 Ohio NICUs. The intervention began in September 2008 and continued through December 2009. Sites used the Institute for Healthcare Improvement Breakthrough Series quality-improvement model to facilitate implementation of evidence-based catheter care. Data were collected monthly for all catheter insertions and for at least 10 observations of indwelling catheter care. NICUs also submitted monthly data on catheter-days, patient-days, and episodes of infection. Data were analyzed by using statistical process control methods.
  
  
  RESULTS
  During the intervention, NICUs submitted information on 1916 infants. Of the 242 infections reported, 69% were catheter associated. Compliance with catheter-insertion components was >90% by April 2009. Compliance with components of evidence-based indwelling catheter care reached 80.4% by December 2009. There was a significant reduction in the proportion of infants with at least 1 late-onset infection from a baseline of 18.2% to 14.3%.
  
  
  CONCLUSIONS
  There was a 20% reduction in the incidence of late-onset infection after the intervention, but the magnitude was less than hypothesized, perhaps because compliance with components of evidence-based care of indwelling catheters remained <90%. Because nearly one-third of infections were not catheter associated, improvement may require attention to other aspects of care such as skin integrity and nutrition.
authors.affiliation: Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229, USA. heather.kaplan@cchmc.org
authors.forename: Heather C
authors.initials: HC
authors.lastname: Kaplan
authors.forename: Carole
authors.initials: C
authors.lastname: Lannon
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
authors.forename: Edward F
authors.initials: EF
authors.lastname: Donovan
mesh_terms: D017668:Age of Onset; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000517:prevention & control; D009820:Ohio / Q000453:epidemiology; D011379:Prognosis; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement / Q000458:organization & administration*; D018805:Sepsis / Q000453:epidemiology* / Q000517:prevention & control