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Volumn 24, Issue 1, 2012, Pages 103-112

Quality improvement interventions to prevent healthcare-associated infections in neonates and children

Author keywords

central line associated bloodstream infection; cross infection; healthcare; healthcare associated infection; infection control; quality assurance; quality improvement

Indexed keywords

BLOODSTREAM INFECTION; CATHETER INFECTION; CROSS INFECTION; HEALTH CARE; HEALTH CARE PERSONNEL; HOSPITAL INFECTION; HUMAN; INFECTION CONTROL; NEWBORN INFECTION; PATIENT SAFETY; PRIORITY JOURNAL; REVIEW; RISK FACTOR; TOTAL QUALITY MANAGEMENT;

EID: 84856100736     PISSN: 10408703     EISSN: 1531698X     Source Type: Journal    
DOI: 10.1097/MOP.0b013e32834ebdc3     Document Type: Review
Times cited : (19)

References (64)
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    • A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit
    • This single-center before after study describes a quality improvement intervention to reduce CLABSI in a neonatal ICU. The incidence of CLABSI decreased from 8.4 to 1.3 cases per 1000 central line days and the incidence of late-onset sepsis decreased from 5.8 to 1.4 cases per 1000 patient-days
    • Bizzarro MJ, Sabo B, Noonan M, et al. A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2010; 31:241-248. This single-center, before/after study describes a quality improvement intervention to reduce CLABSI in a neonatal ICU. The incidence of CLABSI decreased from 8.4 to 1.3 cases per 1000 central line days and the incidence of late-onset sepsis decreased from 5.8 to 1.4 cases per 1000 patient-days.
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    • Nosocomial infection reduction in VLBW infants with a statewide quality-improvement model
    • This multicenter statewide before after study coordinated through the California Perinatal Quality Care Collaborative describes a quality improvement intervention to reduce nosocomial infection in 54 neonatal ICUs. Across all ICUs the rate of nosocomial infection decreased from 16.9% in 2002 to 14.5% in 2006. Infants admitted to ICUs participating in at least one quality improvement event had a lower risk of nosocomial infection compared with those admitted to nonparticipating units
    • Wirtschafter DD, Powers RJ, Pettit JS, et al. Nosocomial infection reduction in VLBW infants with a statewide quality-improvement model. Pediatrics 2011; 127:419-426. This multicenter, statewide, before/after study, coordinated through the California Perinatal Quality Care Collaborative, describes a quality improvement intervention to reduce nosocomial infection in 54 neonatal ICUs. Across all ICUs, the rate of nosocomial infection decreased from 16.9% in 2002 to 14.5% in 2006. Infants admitted to ICUs participating in at least one quality improvement event had a lower risk of nosocomial infection compared with those admitted to nonparticipating units.
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    • Statewide NICU central-lineassociated bloodstream infection rates decline after bundles and checklists
    • This multicenter statewide before after study coordinated by a network of regional referral neonatal ICUs and the State of New York Heath Department describes a quality improvement intervention to reduce CLABSI in 18 neonatal ICUs. Across all ICUs the incidence of CLABSI decreased from 6.4 to 2.1 from 3.5 to 2.1 using the current 2008 NHSN CLABSI definition per 1000 central line days. Greater use of a maintenance checklist was associated with a lower incidence of CLABSI. The study also explored the degree of heterogeneity in results among units
    • Schulman J, Stricof R, Stevens TP, et al. Statewide NICU central-lineassociated bloodstream infection rates decline after bundles and checklists. Pediatrics 2011; 127:436-444. This multicenter, statewide, before/after study, coordinated by a network of regional referral neonatal ICUs and the State of New York Heath Department, describes a quality improvement intervention to reduce CLABSI in 18 neonatal ICUs. Across all ICUs, the incidence of CLABSI decreased from 6.4 to 2.1 (from 3.5 to 2.1 using the current 2008 NHSN CLABSI definition) per 1000 central line days. Greater use of a maintenance checklist was associated with a lower incidence of CLABSI. The study also explored the degree of heterogeneity in results among units.
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    • Miller MR, Niedner MF, Huskins WC, et al. Reduction of PICU central lineassociated bloodstream infections: 3-year results. Pediatrics 2011; 128: e1077-e1083. This time series study, coordinated through the National Association of Children's Hospitals and Related Institutions, describes a follow-up assessment of the quality improvement intervention to reduce CLABSI in 29 pediatric ICUs described initially in Ref. [20 ]. Over 3 years of the intervention, the incidence of CLABSI decreased from 5.4 to 2.3 per 1000 central line days. The study found that 15% of the decrease was due to the 2008 change in NHSN definition of CLABSIs.
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    • This retrospective cohort study examined institutional variation in performance of traditional CLABSI surveillance in 20 ICUs at four medical centers. The incidence of CLABSI determined by infection preventionists using the NHSN CLABSI definition was lower than that determined by a computer algorithm reference standard applied retrospectively using criteria adapted from CDC surveillance definitions. The overall correlation between rates determined by the infection preventionists and computer algorithm was weak. The study concluded that there is significant variation in the application of the CLABSI definition across medical centers which may complicate interinstitutional comparisons of publicly reported CLABSI rates
    • Lin MY, Hota B, Khan YM, et al. Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates. JAMA 2010; 304:2035-2041. This retrospective cohort study examined institutional variation in performance of traditional CLABSI surveillance in 20 ICUs at four medical centers. The incidence of CLABSI determined by infection preventionists using the NHSN CLABSI definition was lower than that determined by a computer algorithm reference standard applied retrospectively using criteria adapted from CDC surveillance definitions. The overall correlation between rates determined by the infection preventionists and computer algorithm was weak. The study concluded that there is significant variation in the application of the CLABSI definition across medical centers, which may complicate interinstitutional comparisons of publicly reported CLABSI rates.
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    • This survey of healthcare professionals in 16 pediatric ICUs found substantial variation in methods timing and resources used to screen and adjudicate CLABSI cases. A surveillance aggressiveness score was devised to quantify practices likely to increase identification of bloodstream infections and found a significant positive correlation between the score and the reported incidence of CLABSI rates
    • Niedner MF. The harder you look, the more you find: catheter-associated bloodstreaminfection surveillance variability.AmJ Infect Control 2010; 38:585-595. This survey of healthcare professionals in 16 pediatric ICUs found substantial variation in methods, timing, and resources used to screen and adjudicate CLABSI cases. A surveillance aggressiveness score was devised to quantify practices likely to increase identification of bloodstream infections, and found a significant positive correlation between the score and the reported incidence of CLABSI rates.
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    • This cross-sectional study of 250 hospitals reporting data on CLABSI to the NHSN found that a central line bundle was associated with a lower incidence of CLABSI only when compliance with the bundle was monitored and was high
    • Furuya EY, Dick A, Perencevich EN, et al. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS One 2011; 6:e15452. This cross-sectional study of 250 hospitals reporting data on CLABSI to the NHSN found that a central line bundle was associated with a lower incidence of CLABSI only when compliance with the bundle was monitored and was high..
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    • Furuya, E.Y.1    Dick, A.2    Perencevich, E.N.3


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