title: Sustained reduction in neonatal nosocomial infections through quality improvement efforts.
abstract: BACKGROUND
  Although reports of reduced nosocomial infections (NI) in very low birth weight infants have been published, the durability of these gains and changes in secondary outcomes, and clinical practices have less often been published.
  
  
  METHODS
  This was a retrospective, observational study of NI reduction in very low birth weight infants at two hospital campuses. The intervention began in 2005 with our renewed quality improvement efforts to reduce NI. We compared outcomes before (2000-2005) and after (2006-2009) the intervention by using univariate and multiple regression analyses.
  
  
  RESULTS
  We reduced NI by 50% comparing 2000-2005 to 2006-2009 (23.6% vs 11.6%, P < .001). Adjusting for covariates, the odds ratio for NI was 0.33 (confidence interval, 0.26 - 0.42, P < .001) in the more recent era. NI were lower even in infants with birth weight 501-1000 grams (odds ratio = 0.38, confidence interval, 0.29 - 0.51, P < .001). We also reduced bronchopulmonary dysplasia (30.2% vs 25.5%, P = .001), median days to regain birth weight (9 vs 8, P = .04), percutaneously placed central venous catheter use (54.8% vs 43.9%, P = .002), median antibiotic days (8 vs 6, P = .003), median total central line days (16 vs 15, P = .01), and median ventilator days (7 vs 5, P = .01). We sustained improvements for three years.
  
  
  CONCLUSIONS
  Quality improvement efforts were associated with sustained reductions in NI, bronchopulmonary dysplasia, antibiotic use, central line use, and ventilator days.
authors.affiliation: Department of Quality and Safety, Children's Hospital & Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404, USA. rob.payne@childrensmn.org
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Payne
authors.forename: Jennifer
authors.initials: J
authors.lastname: Barry
authors.forename: Wendy
authors.initials: W
authors.lastname: Berg
authors.forename: David E
authors.initials: DE
authors.lastname: Brasel
authors.forename: Erik A
authors.initials: EA
authors.lastname: Hagen
authors.forename: Debra
authors.initials: D
authors.lastname: Matthews
authors.forename: Kristin
authors.initials: K
authors.lastname: McCullough
authors.forename: Katherine
authors.initials: K
authors.lastname: Sanger
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Steger
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D058996:Quality Improvement