title: Teamwork in the NICU Setting and Its Association with Health Care-Associated Infections in Very Low-Birth-Weight Infants.
abstract: Background and ObjectiveTeamwork may affect clinical care in the neonatal intensive care unit (NICU) setting. The objective of this study was to assess teamwork climate across NICUs and to test scale-level and item-level associations with health care-associated infection (HAI) rates in very low-birth-weight (VLBW) infants.MethodsCross-sectional study of the association between HAI rates, defined as any bacterial or fungal infection during the birth hospitalization, among 6,663 VLBW infants cared for in 44 NICUs between 2010 and 2012. NICU HAI rates were correlated with teamwork climate ratings obtained in 2011 from 2,073 of 3,294 eligible NICU health professionals (response rate 63%). The relation between HAI rates and NICU teamwork climate was assessed using logistic regression models including NICU as a random effect.ResultsAcross NICUs, 36 to 100% (mean 66%) of respondents reported good teamwork. HAI rates were significantly and independently associated with teamwork climate (odds ratio, 0.82; 95% confidence interval, 0.73-0.92,p= 0.005), such that the odds of an infant contracting a HAI decreased by 18% with each 10% rise in NICU respondents reporting good teamwork.ConclusionImproving teamwork may be an important element in infection control efforts.
authors.affiliation: Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California.|California Perinatal Quality Care Collaborative, Palo Alto, California.
authors.forename: Jochen
authors.initials: J
authors.lastname: Profit
authors.affiliation: California Perinatal Quality Care Collaborative, Palo Alto, California.|Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, California.|Division of Hospitalist Medicine, Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
authors.affiliation: Department of Pediatrics Research and Statistical Unit, Stanford University, Palo Alto, California.
authors.forename: Peiyi
authors.initials: P
authors.lastname: Kan
authors.affiliation: Quantitative Sciences Unit, Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rigdon
authors.affiliation: Quantitative Sciences Unit, Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: Manisha
authors.initials: M
authors.lastname: Desai
authors.affiliation: California Perinatal Quality Care Collaborative, Palo Alto, California.|Division of Hospitalist Medicine, Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: Courtney C
authors.initials: CC
authors.lastname: Nisbet
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Tawfik
authors.affiliation: University of Texas at Houston-Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.affiliation: Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California.|California Perinatal Quality Care Collaborative, Palo Alto, California.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham.|Duke Patient Safety Center, Duke University Health System, Durham.
authors.forename: J Bryan
authors.initials: JB
authors.lastname: Sexton
mesh_terms: D001291:Attitude of Health Personnel; D003428:Cross Infection / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006126:Group Processes; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D015279:Organizational Culture; D010348:Patient Care Team; D061214:Patient Safety; D011795:Surveys and Questionnaires