title: The impact of a sepsis quality improvement project on neurodisability rates in very low birthweight infants.
abstract: OBJECTIVE
  Very low birthweight (VLBW; <1500 g) infants with late-onset sepsis (LOS) have an increased risk of neurodisability. Care bundles to reduce bloodstream infections in neonatal intensive care unit (NICU) are effective in reducing LOS. Our aim was to determine if a sepsis reduction bundle introduced through a quality improvement project would impact neurodevelopmental outcomes in VLBW infants.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Level 3 regional NICU in the South West of England.
  
  
  METHODS
  VLBW infants born between 2002 and 2011.
  
  
  METHODS
  A sepsis reduction care bundle implemented between July 2006 and December 2007.
  
  
  METHODS
  The primary outcome was risk of coagulase-negativeStaphylococcus(CONS) infection diagnosed >3 days of age. Secondary outcomes were death and moderate cognitive impairment. A logistic regression model was derived using the birth era as the independent variable with adjustment for typical confounders.
  
  
  RESULTS
  In total, 379 infants were born in the preintervention cohort and 378 in the postintervention cohort. The CONS infection rate was reduced after the intervention (26.7% vs 14.1% p<0.001). Death prior to discharge reduced without reaching statistical significance (14.1% vs10.9%, p=0.195). The rate of cognitive disability reduced in the postintervention cohort (18.8% vs 6.1%, p=0.042). The adjusted ORs (95% CI) for CONS infection, death and cognitive impairment were 0.46 (0.29 to 0.72), 0.73 (0.43 to 1.24) and 0.3 (0.07 to 1.33), respectively.
  
  
  CONCLUSIONS
  There appears to be an association between reduced cognitive disability and the implementation of a sepsis reduction bundle. Further study in larger series is required to confirm these findings.
authors.affiliation: Regional Neonatal Unit, St. Michael's Hospital, University Hospitals Bristol Foundation NHS Trust, Bristol, UK.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Davis
authors.affiliation: Regional Neonatal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.|School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: David
authors.initials: D
authors.lastname: Odd
authors.affiliation: Regional Neonatal Unit, St. Michael's Hospital, University Hospitals Bristol Foundation NHS Trust, Bristol, UK.|School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Jary
authors.affiliation: Regional Neonatal Unit, St. Michael's Hospital, University Hospitals Bristol Foundation NHS Trust, Bristol, UK.|School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Luyt
keywords: Neonatal infection; Neurodisability; Quality improvement