title: Nosocomial infection reduction in VLBW infants with a statewide quality-improvement model.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: David D. Wirtschafter, MD, Inc, San Jose, California, USA. david.wirtschafter@juno.com
authors.forename: David D
authors.initials: DD
authors.lastname: Wirtschafter
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Powers
authors.forename: Janet S
authors.initials: JS
authors.lastname: Pettit
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lee
authors.forename: W John
authors.initials: WJ
authors.lastname: Boscardin
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ahmad Subeh
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Gould
mesh_terms: D002140:California / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D008297:Male; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement