Tracking neonatal nosocomial infection: the continuous quality improvement cycle

Area of Science:

• Neonatology
• Infectious Disease Control
• Quality Improvement in Healthcare

Background:

• Neonatal nosocomial infections (NNI) are a significant cause of mortality, morbidity, and increased healthcare costs in neonatal intensive care units.
• Effective management of NNI requires meticulous care, a culture of change, and continuous quality improvement cycles.

Purpose of the Study:

• To describe the implementation of a multidisciplinary quality improvement team (QIT) and infection control bundles to reduce NNI.
• To evaluate the impact of these interventions on NNI rates in extremely premature infants.

Main Methods:

• A seven-year study in a large perinatal center utilizing control charting methodology for statistical tracking of NNI.
• Implementation of infection control bundles focusing on asepsis, hand hygiene, central line care, blood culture collection, and environmental improvements.
• Formation of a multidisciplinary QIT to oversee the process and provide feedback.

Main Results:

• A statistically significant decline in NNI rates from 13 to seven episodes per 1000 bed-days (censored to day 35) for infants less than 29 weeks gestation.
• Demonstrated successful closure of the QIT loop, linking interventions to measurable improvements.
• Sustained reduction in NNI attributed to the implemented care bundles and continuous monitoring.

Conclusions:

• Multidisciplinary quality improvement teams and the implementation of specific infection control bundles are effective in reducing NNI in neonatal intensive care units.
• Continuous quality improvement cycles, including statistical tracking and feedback, are crucial for sustained reductions in healthcare-associated infections.
• This study provides evidence for the successful application of care bundles in improving neonatal outcomes by reducing NNI.