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Evaluation and development of potentially better practices to prevent neonatal nosocomial bacteremia
Howard W Kilbride1, Richard Powers, David D Wirtschafter
1Children's Mercy Hospitals and Clinics, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri 64108, USA. hkilbride@cmh.edu
Objective:
Six neonatal intensive care units (NICUs) that are members of the Vermont Oxford National Evidence-Based Quality Improvement Collaborative for Neonatology collaborated to reduce infection rates. There were 7 centers in the original focus group, but 1 center left the collaborative after 1 year. The objective of this study was to develop strategies to decrease nosocomial infection rates in NICUs.
Methods:
The process included a comprehensive literature review, internal practice analyses, benchmark studies, and development of practical experience through rapid-cycle changes, subsequent analysis, and feedback. This process led to 3 summary statements on potentially better practices in handwashing, approach to nosocomial sepsis evaluations, and central venous catheter management.
Results:
These statements provide a basis for an evidence-based approach to lowering neonatal intensive care unit nosocomial infection rates.
Conclusions:
The 2-year process also led to changes in the culture and habits of the institutions involved, which should in turn have long-term effects on other aspects of quality improvement.