title: The impact of a quality improvement intervention to reduce nosocomial infections in a PICU.
abstract: OBJECTIVE
  To evaluate whether a quality improvement intervention could reduce nosocomial infection rates in a PICU and improve patient outcomes.
  
  
  METHODS
  Prospective interventional cohort study conducted during three periods: preintervention period, intervention period, and long-term follow-up.
  
  
  METHODS
  A 14-bed medical and surgical PICU in a university hospital for children.
  
  
  METHODS
  The quality improvement intervention consisted of the creation of an infection control team, a program targeting hand hygiene, and quality practices focused on preventing nosocomial infections.
  
  
  RESULTS
  We included 851 patients in the preintervention period, 822 in the intervention period, and 940 in the long-term follow-up period. Compared with the preintervention period, in the intervention period, the rates of central line-associated bloodstream infection decreased from 8.1 to 6/1,000 central venous catheter-days (p = 0.640), ventilator-associated pneumonia decreased from 28.3 to 10.6/1,000 days' ventilation (p = 0.005), and catheter-associated urinary tract infection decreased from 23.3 to 5.8/1,000 urinary catheter-days (p < 0.001). Furthermore, hospital length of stay decreased from 18.56 to 14.57 days (p = 0.035) and mortality decreased from 5.1% to 3.3% (p = 0.056). Multivariable logistic regression found that nosocomial infections was independently associated with increased mortality (odds ratio, 2.35 [95% CI, 1.02-5.55]; p = 0.046). Compared with the preintervention period, in the long-term follow-up period, central line-associated bloodstream infection decreased to 4.6/1,000 central venous catheter-days (p = 0.205); ventilator-associated pneumonia decreased to 9.1/1,000 ventilation-days (p = 0.001), and catheter-associated urinary tract infection decreased to 5.2/1,000 urinary catheter-days (p < 0.001). Hospital length of stay (14.45 days; p = 0.048) and mortality (3.2%; p = 0.058) also decreased.
  
  
  CONCLUSIONS
  A multifaceted quality improvement intervention reduced nosocomial infection rates, hospital length of stay, and mortality in our PICU. The effects of the intervention were sustained over time.
authors.affiliation: Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Esteban
authors.forename: Ricard
authors.initials: R
authors.lastname: Ferrer
authors.forename: Mireya
authors.initials: M
authors.lastname: Urrea
authors.forename: David
authors.initials: D
authors.lastname: Suarez
authors.forename: Librada
authors.initials: L
authors.lastname: Rozas
authors.forename: Monica
authors.initials: M
authors.lastname: Balaguer
authors.forename: Antonio
authors.initials: A
authors.lastname: Palomeque
authors.forename: Iolanda
authors.initials: I
authors.lastname: Jordan
mesh_terms: D000046:Academic Medical Centers; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000401:mortality / Q000517:prevention & control*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods / Q000458:organization & administration / Q000639:trends; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration* / Q000592:standards; D007902:Length of Stay; D016015:Logistic Models; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D015397:Program Evaluation; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration*