title: The Implementation of an Evidence-Based Bundle for Bloodstream Infections in Neonatal Intensive Care Units in Germany: A Controlled Intervention Study to Improve Patient Safety.
abstract: OBJECTIVE To improve the patient safety of very-low-birthweight infants in neonatal departments in Germany. DESIGN Multicenter cohort study with a baseline (24 months), an intervention (12 months), and a postinterventional follow-up period (12 months) and time series analysis. STUDY POPULATION Very-low-birthweight patients from 32 neonatal departments in Germany. METHODS Neonatal departments showing a standardized infection ratio of bloodstream infection 10% higher than the expected number (standardized infection ratio ≥1.1) were invited to participate in the study. To reduce the occurrence of primary bloodstream infections, evidence-based bundles to improve catheter maintenance routines, insertion practice, and hand-hygiene compliance were implemented in the participating infirmaries. RESULTS Thirty-four departments participated in the study and 32 reported data. In total, 6,222 very-low-birthweight infants with 231,868 patient-days and 1,405 cases of bloodstream infections were analyzed. In the baseline period the pooled mean bloodstream infection rate was 6.63 (95% CI, 6.17-7.12) per 1,000 patient-days. The bloodstream infection rate decreased in the intervention period to 5.68 (relative risk, 0.86 [95% CI, 0.76-0.97]) and in the 1-year follow-up period to 5.31 per 1,000 patient-days (relative risk, 0.80 [95% CI, 0.70-0.92]). The multivariable time series analysis of monthly aggregated data showed a significant change in the slope for the frequency of bloodstream infections from the start to the end of the intervention (change in slope incidence rate ratio, 0.97; P=.001). CONCLUSION The implementation of an intervention bundle is feasible and can reduce bloodstream infections in neonatal departments. Infect Control Hosp Epidemiol 2016;37:798-804.
authors.affiliation: Institute of Hygiene and Environmental Medicine,Charité University Medical Center Berlin,German National Reference Center for the Surveillance of Nosocomial Infections,Hindenburgdamm,Berlin,Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Salm
authors.affiliation: Institute of Hygiene and Environmental Medicine,Charité University Medical Center Berlin,German National Reference Center for the Surveillance of Nosocomial Infections,Hindenburgdamm,Berlin,Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.affiliation: Institute of Hygiene and Environmental Medicine,Charité University Medical Center Berlin,German National Reference Center for the Surveillance of Nosocomial Infections,Hindenburgdamm,Berlin,Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Geffers
authors.affiliation: Institute of Hygiene and Environmental Medicine,Charité University Medical Center Berlin,German National Reference Center for the Surveillance of Nosocomial Infections,Hindenburgdamm,Berlin,Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.affiliation: Institute of Hygiene and Environmental Medicine,Charité University Medical Center Berlin,German National Reference Center for the Surveillance of Nosocomial Infections,Hindenburgdamm,Berlin,Germany.
authors.forename: Brar
authors.initials: B
authors.lastname: Piening
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005858:Germany / Q000453:epidemiology; D063373:Hand Hygiene; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000517:prevention & control; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration / Q000706:statistics & numerical data*; D008297:Male; D064872:Patient Care Bundles; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control