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PEDIATRICS Vol. 111 No. 4 April 2003, pp. e519-e533

ELECTRONIC ARTICLE

Implementation of Evidence-Based Potentially Better Practices to Decrease Nosocomial Infections

Howard W. Kilbride, MD*, David D. Wirtschafter, MD{ddagger}, Richard J. Powers, MD§ and Michael B. Sheehan, MD*

* Children’s Mercy Hospitals and Clinics, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
{ddagger} Kaiser Foundation Hospital, Los Angeles, California
§ Children’s Hospital Oakland, Oakland, California

--> Objective. Six neonatal intensive care units (NICUs) that are members of the Vermont Oxford National Evidence-Based Quality Improvement Collaborative for Neonatology collaborated to reduce infection rates. There were 7 centers in the original focus group, but 1 center left the collaborative after 1 year. Nosocomial infection is a significant area for improvement in most NICUs.

Methods. Six NICUs participating in the Vermont Oxford Network made clinical changes to address 3 areas of consensus: handwashing, line management, and accuracy of diagnosis. The summary statements were widely communicated. Review of the literature, internal assessments, and benchmarking visits all contributed to ideas for change.

Results. The principle outcome was the incidence of coagulase-negative staphylococcus bacteremia. There was an observed reduction from 24.6% in 1997 to 16.4% in 2000.

Conclusions. The collaborative process for clinical quality improvement can result in effective practice changes.

Key Words: nosocomial infection • handwashing • line management • blood cultures • collaborative quality improvement • NIC/Q 2000

Abbreviations: NI, nosocomial infection • VON, Vermont Oxford Network • CONS, coagulase-negative staphylococcus • PBPs, potentially better practices • NICU, neonatal intensive care unit • PDSA, plan-do-study-act

Received for publication Aug 13, 2002; Accepted Oct 24, 2002.




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