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Updated: Jun 4, 2026
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Ohio statewide quality-improvement collaborative to reduce late-onset sepsis in preterm infants
Heather C Kaplan1, Carole Lannon, Michele C Walsh
1Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229, USA. heather.kaplan@cchmc.org
Insights
Quality improvement methods reduced late-onset infections in preterm infants by 20%. Further improvements in catheter care and other factors are needed to fully prevent nosocomial infections.
Area of Science:
- Neonatalogy
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- Late-onset bacterial infections pose a significant risk to premature infants.
- Catheter-associated infections are a common source of nosocomial infections in Neonatal Intensive Care Units (NICUs).
- Evidence-based catheter care protocols aim to mitigate infection risks.
Purpose of the Study:
- To implement evidence-based catheter care in NICUs using collaborative quality improvement.
- To reduce the incidence of late-onset bacterial infections in infants born between 22 to 29 weeks' gestation.
- To achieve a 50% reduction in nosocomial infections through improved catheter care.
Main Methods:
- An interrupted time-series study was conducted across 24 Ohio NICUs.
- Collaborative quality improvement methods, including the Institute for Healthcare Improvement Breakthrough Series model, were employed.
- Data on catheter insertions, indwelling catheter care observations, catheter-days, patient-days, and infections were collected monthly and analyzed using statistical process control.
Main Results:
- The intervention involved 1916 infants, with 69% of 242 reported infections being catheter-associated.
- Compliance with catheter insertion protocols exceeded 90% by April 2009.
- Compliance with indwelling catheter care reached 80.4% by December 2009, with a significant reduction in late-onset infections from 18.2% to 14.3%.
Conclusions:
- A 20% reduction in late-onset infection incidence was observed post-intervention, falling short of the 50% hypothesis.
- Suboptimal compliance (<90%) with indwelling catheter care may have limited the reduction.
- Addressing non-catheter-associated infections through improved skin integrity and nutrition is crucial for further prevention.
Objective:
We aimed to reduce late-onset bacterial infections in infants born at 22 to 29 weeks' gestation by using collaborative quality-improvement methods to implement evidence-based catheter care. We hypothesized that these methods would result in a 50% reduction in nosocomial infection.
Patients And Methods:
We conducted an interrupted time-series study among 24 Ohio NICUs. The intervention began in September 2008 and continued through December 2009. Sites used the Institute for Healthcare Improvement Breakthrough Series quality-improvement model to facilitate implementation of evidence-based catheter care. Data were collected monthly for all catheter insertions and for at least 10 observations of indwelling catheter care. NICUs also submitted monthly data on catheter-days, patient-days, and episodes of infection. Data were analyzed by using statistical process control methods.
Results:
During the intervention, NICUs submitted information on 1916 infants. Of the 242 infections reported, 69% were catheter associated. Compliance with catheter-insertion components was >90% by April 2009. Compliance with components of evidence-based indwelling catheter care reached 80.4% by December 2009. There was a significant reduction in the proportion of infants with at least 1 late-onset infection from a baseline of 18.2% to 14.3%.
Conclusions:
There was a 20% reduction in the incidence of late-onset infection after the intervention, but the magnitude was less than hypothesized, perhaps because compliance with components of evidence-based care of indwelling catheters remained <90%. Because nearly one-third of infections were not catheter associated, improvement may require attention to other aspects of care such as skin integrity and nutrition.
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