D D Wirtschafter, J Pettit, P Kurtin^, et al.  A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections.  Journal of Perinatology (2010) 30, 170–181.  PDF of Article

Objective:  The objective of this study was to reduce central line-associated blood stream infections (CLABSIs) among 13 collaborating regional neonatal intensive care units by 25%. We tested the hypothesis that change could be attributed to the quality improvement collaborative by testing for ‘special cause’ variation.

Study Design:  Our prevention project included five features: (1) leadership commitment, (2) potentially best practices, (3) collaborative processes, (4) audit and feedback tools and (5) quality improvement techniques. Baseline (1 January 2006 to 30 August 2006) data were compared with the intervention (1 September 2006 to 30 June 2007) and post-intervention (1 July 2007 to 30 December 2007) periods and analyzed using statistical process control (SPC) methods.

Result:  We detected special cause variation, suggesting that the collaborative was associated with reduced infection rates, from 4.32 to 3.22 per 1000 line days (a 25% decrease) when comparing the baseline with the follow-up period.

Conclusion:  The collaborative's process was associated with fewer infections. SPC suggested that systematic changes occurred. The remaining challenges include sustaining or even further reducing the infection rate.

Comments:  The present study describes the successful collaboration of 13 California NICUs in reducing neonatal CLABSIs by 25%.  The potentially-better practices that were implemented to achieve this goal can be found in the The Nosocomial Infection Prevention Toolkit, 2003 edition, of the California Perinatal Quality Care Collaborative.   The latest version of this toolkit can be seen here.  There are many great tools (worksheets, checklists, tracking tools, etc) in this toolkit.  I encourage you to check it out. 

Many of us have struggled with trying to sustain low nosocomial infection rates in our NICUs.  Our own experience has been one of intermittent success.  Several of our VON NICUs participated in this project.  If yours was one of them, please share your experiences with us here.   If your NICU has consistantly performed well in this measure, please share your secrets of success with us on this blog.  We look forward to hearing your comments.  Andy Kairalla MD