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79952643764
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Vital signs: Central line-associated blood stream infections-United States 2001 2008 and 2009
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Centers for Disease Control and Prevention A report from the CDC's NHSN describes a 58% decrease in the incidence of CLABSI in US ICU in 2009 compared with 2001. The reduction in CLABSI was greatest for Staphylococcus aureus CLABSIs 73% reduction and more modest for CLABSIs caused by Gram-negative pathogens 37% reduction Candida spp. 46% reduction and Enterococcus spp. 55% reduction
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Centers for Disease Control and Prevention. Vital signs: central line-associated blood stream infections - United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011; 60:243-248. A report from the CDC's NHSN describes a 58% decrease in the incidence of CLABSI in US ICU in 2009 compared with 2001. The reduction in CLABSI was greatest for Staphylococcus aureus CLABSIs (73% reduction) and more modest for CLABSIs caused by Gram-negative pathogens (37% reduction), Candida spp. (46% reduction), and Enterococcus spp. (55% reduction).
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(2011)
MMWR Morb. Mortal. Wkly. Rep.
, vol.60
, pp. 243-248
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79955641279
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Preventing bloodstream infections: A measurable national success story in quality improvement
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This publication describes how the effort to reduce CLABSI that began in Michigan and has subsequently been extended nationally serves as a case model of a successful patient safety initiative. The article describes how the alignment of stakeholders with a unified sense of measurable goals social and policy pressures and management financial and regulatory levers can be combined to create incentive drive change and hold healthcare organizations accountable for better patient safety performance
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Pronovost PJ, Marsteller JA, Goeschel CA. Preventing bloodstream infections: a measurable national success story in quality improvement. Health Aff (Millwood) 2011; 30:628-634. This publication describes how the effort to reduce CLABSI that began in Michigan and has subsequently been extended nationally serves as a 'case model' of a successful patient safety initiative. The article describes how the alignment of stakeholders with a unified sense of measurable goals, social and policy pressures, and management, financial, and regulatory levers can be combined to create incentive, drive change, and hold healthcare organizations accountable for better patient safety performance.
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(2011)
Health Aff. Millwood.
, vol.30
, pp. 628-634
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Pronovost, P.J.1
Marsteller, J.A.2
Goeschel, C.A.3
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3
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77952359694
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Patient safety at ten: Unmistakable progress troubling gaps
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This editorial reviews the efforts to improve patient safety during the decade of the 2000s identifying important improvements as well as areas where progress has been inadequate and barriers to change still exist
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Wachter RM. Patient safety at ten: unmistakable progress, troubling gaps. Health Aff (Millwood) 2010; 29:165-173. This editorial reviews the efforts to improve patient safety during the decade of the 2000s, identifying important improvements as well as areas where progress has been inadequate and barriers to change still exist.
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(2010)
Health Aff. Millwood
, vol.29
, pp. 165-173
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Wachter, R.M.1
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4
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78649439268
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Temporal trends in rates of patient harm resulting from medical care
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This retrospective study identified rates of harm to patients in a stratified random sample of 10 hospitals in North Carolina from 2002 through 2007. The incidence of harm was 25 per 100 admissions with a small and not significant rate of reduction in preventable harms during the study period
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Landrigan CP, Parry GJ, Bones CB, et al. Temporal trends in rates of patient harm resulting from medical care. N Engl J Med 2010; 363:2124-2134. This retrospective study identified rates of harm to patients in a stratified random sample of 10 hospitals in North Carolina from 2002 through 2007. The incidence of harm was 25 per 100 admissions, with a small and not significant rate of reduction in preventable harms during the study period.
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(2010)
N. Engl. J. Med.
, vol.363
, pp. 2124-2134
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Landrigan, C.P.1
Parry, G.J.2
Bones, C.B.3
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5
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77957888077
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Moving toward elimination of healthcare-associated infections: A call to action
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Led by the CDC a group of governmental agencies and professional societies call for effort to eliminate healthcare-associated infections by promoting adherence to evidence-based prevention practices aligning financial incentives and reinvestment in successful strategies addressing knowledge gaps to respond to emerging threats through basic translational and epidemiological research and collecting data to target prevention efforts and to measure progress
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Cardo D, Dennehy PH, Halverson P, et al. Moving toward elimination of healthcare-associated infections: a call to action. Infect Control Hosp Epidemiol 2010; 31:1101-1105. Led by the CDC, a group of governmental agencies and professional societies call for effort to eliminate healthcare-associated infections by promoting adherence to evidence-based prevention practices; aligning financial incentives and reinvestment in successful strategies; addressing knowledge gaps to respond to emerging threats through basic, translational, and epidemiological research; and collecting data to target prevention efforts and to measure progress.
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Infect. Control. Hosp. Epidemiol.
, vol.31
, pp. 1101-1105
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Cardo, D.1
Dennehy, P.H.2
Halverson, P.3
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6
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78751675044
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Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs
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This systematic review estimates that as many as 65-70% of cases of CLABSI and catheter-associated urinary tract infection and 55% of cases of ventilatorassociated pneumonia and surgical site infection may be reasonably preventable with existing evidence-based practice From these data, the investigators calculated the annual number of preventable infections and deaths and costs for each type of healthcare-associated infection
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Umscheid CA, Mitchell MD, Doshi JA, et al. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011; 32:101-114. This systematic review estimates that as many as 65-70% of cases of CLABSI and catheter-associated urinary tract infection and 55% of cases of ventilatorassociated pneumonia and surgical site infection may be 'reasonably preventable' with existing evidence-based practice. From these data, the investigators calculated the annual number of preventable infections and deaths and costs for each type of healthcare-associated infection.
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(2011)
Infect. Control. Hosp. Epidemiol.
, vol.32
, pp. 101-114
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Umscheid, C.A.1
Mitchell, M.D.2
Doshi, J.A.3
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7
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Estimating the cost of healthcareassociated infections: Mind your ps and qs
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This perspective critically reviews the literature on estimates of the economic costs of healthcare-associated infections and concludes current estimates are likely overestimates due to the inability to adequately control for confounding variables that are associated with both infections and cost and the failure to consider timedependent bias in calculating costs
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Graves N, Harbarth S, Beyersmann J, et al. Estimating the cost of healthcareassociated infections: mind your p's and q's. Clin Infect Dis 2010; 50:1017-1021. This perspective critically reviews the literature on estimates of the economic costs of healthcare-associated infections and concludes current estimates are likely overestimates due to the inability to adequately control for confounding variables that are associated with both infections and cost and the failure to consider timedependent bias in calculating costs.
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(2010)
Clin. Infect. Dis.
, vol.50
, pp. 1017-1021
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Graves, N.1
Harbarth, S.2
Beyersmann, J.3
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8
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80051775787
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The importance of good data analysis and interpretation for showing the economics of reducing healthcare-associated infection
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This letter to the editor critiques the methods and findings of Ref 6
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Graves N, Barnett AG, Halton K, et al. The importance of good data, analysis, and interpretation for showing the economics of reducing healthcare-associated infection. Infect Control Hosp Epidemiol 2011; 32:927-928. This letter to the editor critiques the methods and findings of Ref. [6 ].
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Infect. Control. Hosp. Epidemiol.
, vol.32
, pp. 927-928
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Graves, N.1
Barnett, A.G.2
Halton, K.3
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84856097349
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HAI reporting laws and regulations Available from Accessed 31 August
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Association for Professionals in Infection Control and Epidemiology, Inc. HAI reporting laws and regulations. Available from http://www.apic.org/ downloads/ legislation/HAI-map.gif. [Accessed 31 August 2011]
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(2011)
Association for Professionals in Infection Control and Epidemiology Inc.
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77956809381
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First state-specific healthcareassociated infections summary data report: CDCs National Healthcare Safety Network NHSN January-June 2009 Available from Accessed 31 August 2011
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Centers for Disease Control and Prevention. First state-specific healthcareassociated infections summary data report: CDC's National Healthcare Safety Network (NHSN) January-June, 2009. Available from http:// www.cdc.gov/hai/statesummary.html. [Accessed 31 August 2011]
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Centers for Disease Control and Prevention
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Teaching hospitals not always best for patient safety
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Available from Accessed 31 August 2011
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Consumers Union. Teaching hospitals not always best for patient safety. Available from http://news.consumerreports.org/health/2011/06/teachinghospitals- not-always-best-for-patient-safety.html. [Accessed 31 August 2011]
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Consumers Union
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79957801081
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A new frontier in patient safety
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This publication announces a new national effort to improve patient safety the Partnership for Patients led by the United States Department of Health and Human Services. The aims of the project are to accelerate the reduction of harmto patients in hospitals and to decrease preventable hospital readmissions within 30 days of discharge. The program expects to reduce injuries to patients and readmission rates substantially with resulting decreases in inpatient deaths and healthcare costs
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McCannon J, Berwick DM. A new frontier in patient safety. JAMA 2011; 305:2221-2222. This publication announces a new national effort to improve patient safety, the 'Partnership for Patients', led by the United States Department of Health and Human Services. The aims of the project are to accelerate the reduction of harmto patients in hospitals and to decrease preventable hospital readmissions within 30 days of discharge. The program expects to reduce injuries to patients and readmission rates substantially, with resulting decreases in inpatient deaths and healthcare costs.
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(2011)
JAMA
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, pp. 2221-2222
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McCannon, J.1
Berwick, D.M.2
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13
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79953907296
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Healthcare-associated infections in children
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This commentary outlines the priorities for efforts to reduce healthcare-associated infections in children
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Foster CB, Sabella C. Healthcare-associated infections in children. JAMA 2011; 305:1480-1481. This commentary outlines the priorities for efforts to reduce healthcare-associated infections in children.
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(2011)
JAMA
, vol.305
, pp. 1480-1481
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Foster, C.B.1
Sabella, C.2
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Steering committee on quality improvement and management and committee on hospital care american academy of pediatrics policy statement-principles of pediatric patient safety: Reducing harm due to medical care
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This policy statement from the American Academy of Pediatrics makes recommendations related to three efforts necessary to reduce harm due to medical care in children: Raising awareness and improving knowledge of pediatric patient safety issues and best practices throughout the pediatric community acting and advocating to minimize preventable pediatric medical harm by using information on pediatricspecific patient safety risk and improving healthcare outcomes for children by adhering to proven best practices for improving pediatric patient safety
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Steering Committee on Quality Improvement and Management and Committee on Hospital Care, American Academy of Pediatrics. Policy statement - principles of pediatric patient safety: reducing harm due to medical care. Pediatrics 2011; 127:1199-1210. This policy statement from the American Academy of Pediatrics makes recommendations related to three efforts necessary to reduce harm due to medical care in children: raising awareness and improving knowledge of pediatric patient safety issues and best practices throughout the pediatric community; acting and advocating to minimize preventable pediatric medical harm by using information on pediatricspecific patient safety risk; and improving healthcare outcomes for children by adhering to proven best practices for improving pediatric patient safety.
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(2011)
Pediatrics
, vol.127
, pp. 1199-1210
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15
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77957558263
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Reducing catheter-associated bloodstream infections in the pediatric intensive care unit: Business case for quality improvement
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This matched cohort study calculated the excess length of stay and healthcare costs attributable to central line-associated bloodstream infection in a pediatric ICU. Using this information, the authors describe a business case for quality improvement efforts to reduce these infections
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Nowak JE, Brilli RJ, Lake MR, et al. Reducing catheter-associated bloodstream infections in the pediatric intensive care unit: business case for quality improvement. Pediatr Crit Care Med 2010; 11:579-587. This matched cohort study calculated the excess length of stay and healthcare costs attributable to central line-associated bloodstream infection in a pediatric ICU. Using this information, the authors describe a business case for quality improvement efforts to reduce these infections.
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Pediatr Crit. Care Med.
, vol.11
, pp. 579-587
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Nowak, J.E.1
Brilli, R.J.2
Lake, M.R.3
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79957918737
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A new framework for quality partnerships in childrens hospitals
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In this article hospital executives and pediatric department chairs from 14 childrens hospitals discuss their efforts to integrate quality programs with focus on: Aligning quality priorities and resources across the organizations educating and training for physicians in the science of improvement and professional development and career progression for physicians in recognition of quality improvement activities
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Levy FH, Brilli RJ, First LR, et al. A new framework for quality partnerships in children's hospitals. Pediatrics 2011; 127:1147-1156. In this article, hospital executives and pediatric department chairs from 14 children's hospitals discuss their efforts to integrate quality programs, with focus on: aligning quality priorities and resources across the organizations; educating and training for physicians in the science of improvement; and professional development and career progression for physicians in recognition of quality improvement activities.
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Pediatrics
, vol.127
, pp. 1147-1156
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Levy, F.H.1
Brilli, R.J.2
First, L.R.3
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Neonatal intensive care unit collaboration to decrease hospital-acquired bloodstream infections: From comparative performance reports to improvement networks
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Schulman J, Wirtschafter DD, Kurtin P. Neonatal intensive care unit collaboration to decrease hospital-acquired bloodstream infections: from comparative performance reports to improvement networks. Pediatr Clin North Am 2009; 56:865-892.
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Pediatr Clin. North. Am.
, vol.56
, pp. 865-892
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Schulman, J.1
Wirtschafter, D.D.2
Kurtin, P.3
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The vermont oxford network: A community of practice
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This article reviews the work of the Vermont Oxford Network in improving neonatal care
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Horbar JD, Soll RF, Edwards WH. The Vermont Oxford Network: a community of practice. Clin Perinatol 2010; 37:29-47. This article reviews the work of the Vermont Oxford Network in improving neonatal care.
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, vol.37
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Horbar, J.D.1
Soll, R.F.2
Edwards, W.H.3
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Prevention of central venous catheterassociated bloodstream infections in pediatric intensive care units: A performance improvement collaborative
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Jeffries HE, Mason W, Brewer M, et al. Prevention of central venous catheterassociated bloodstream infections in pediatric intensive care units: a performance improvement collaborative. Infect Control Hosp Epidemiol 2009; 30:645-651.
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Jeffries, H.E.1
Mason, W.2
Brewer, M.3
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20
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76049094205
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Decreasing PICU catheter-associated bloodstream infections: NACHRIs quality transformation efforts
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This time series study, coordinated through the National Association of Children's Hospitals and Related Institutions, describes a quality improvement intervention to reduce CLABSI in 29 pediatric intensive care units. The average incidence of CLABSI decreased from 5.4 to 3.1 per 1000 central line days.
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Miller MR, Griswold M, Harris JM, et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts. Pediatrics 2010; 125:206-213. This time series study, coordinated through the National Association of Children's Hospitals and Related Institutions, describes a quality improvement intervention to reduce CLABSI in 29 pediatric intensive care units. The average incidence of CLABSI decreased from 5.4 to 3.1 per 1000 central line days.
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(2010)
Pediatrics
, vol.125
, pp. 206-213
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Miller, M.R.1
Griswold, M.2
Harris, J.M.3
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Using care bundles to prevent infection in neonatal and paediatric ICUs
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Lachman P, Yuen S. Using care bundles to prevent infection in neonatal and paediatric ICUs. Curr Opin Infect Dis 2009; 22:224-228.
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Curr. Opin Infect. Dis.
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, pp. 224-228
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Lachman, P.1
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Prevention of healthcare-associated infections in children: New strategies and success stories
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Sandora TJ. Prevention of healthcare-associated infections in children: new strategies and success stories. Curr Opin Infect Dis 2010; 23:300-305.
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, pp. 300-305
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Sandora, T.J.1
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Simple strategies to reduce healthcare associated infections in the neonatal intensive care unit: Line tube and hand hygiene
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Graham PL. Simple strategies to reduce healthcare associated infections in the neonatal intensive care unit: line, tube, and hand hygiene. Clin Perinatol 2010; 37:645-653.
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Powers RJ, Wirtschafter DW. Decreasing central line associated bloodstream infection in neonatal intensive care. Clin Perinatol 2010; 37:247-272.
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Powers, R.J.1
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Li S, Bizzarro MJ. Prevention of central line associated bloodstream infections in critical care units. Curr Opin Pediatr 2011; 23:85-90.
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Li, S.1
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Safe but sound: Patient safety meets evidence-based medicine
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Shojania KG, Duncan BW, McDonald KM, Wachter RM. Safe but sound: patient safety meets evidence-based medicine. JAMA 2002; 288:508-513. (Pubitemid 34787486)
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Berwick DM. The science of improvement. JAMA 2008; 299:1182-1184. 30. Ogrinc G, Mooney SE, Estrada C, et al. The SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration. Qual Saf Healthcare 2008; 17 (Suppl. 1):i13-i32.
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How to use an article about quality improvement
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This Users Guide to the Medical Literature focuses on how to review and use reports of studies examining the effects of quality improvement interventions
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Fan E, Laupacis A, Pronovost PJ, et al. How to use an article about quality improvement. JAMA 2010; 304:2279-2287. This 'Users' Guide to the Medical Literature' focuses on how to review and use reports of studies examining the effects of quality improvement interventions.
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Fan, E.1
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Advancing the science of patient safety
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Sponsored by the Agency for Healthcare Research and Quality an international group of experts in patient safety and evaluation methods recommend that reports of interventions to improve patient safety should include greater use of theory and logic models more detailed descriptions of interventions and their implementation enhanced explanation of desired and unintended outcomes and better description and measurement of context and of how context influences interventions
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Shekelle PG, Pronovost PJ, Wachter RM, et al. Advancing the science of patient safety. Ann Intern Med 2011; 154:693-696. Sponsored by the Agency for Healthcare Research and Quality, an international group of experts in patient safety and evaluation methods recommend that reports of interventions to improve patient safety should include greater use of theory and logic models, more detailed descriptions of interventions and their implementation, enhanced explanation of desired and unintended outcomes, and better description and measurement of context and of how context influences interventions.
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A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit
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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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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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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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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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Kaplan HC, Lannon C, Walsh MC, Donovan EF. Ohio statewide qualityimprovement collaborative to reduce late-onset sepsis in preterm infants. Pediatrics 2011; 127:427-435. This multi-center, statewide, time-series study, coordinated through the Ohio Perinatal Quality Collaborative, describes the effect of a QI intervention to reduce late onset sepsis in preterm infants in 24 neonatal ICUs. Aggregate adherence to a central line insertion bundle increased to >90% after 7 months and remained high throughout the remainder of the study. Aggregate adherence to a central line maintenance bundle increased slowly and reached 80% only after 15 months (the last month of the study). Across all ICUs, late onset sepsis decreased in preterm infants from 18.2% in 2006-2008 to 14.3% in 2008-2009.
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