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A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections

Journal of Perinatology volume 30, pages 170–181 (2010)Cite this article

Abstract

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.

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Acknowledgements

We acknowledge the leadership of the California Children's Hospital Association for their support of this project, and, in particular, Ms Charity Bracy, Vice President for Government Relations and Policy, for her superb organizational support. We also acknowledge Mr Steven Kloman for his extraordinary efforts in helping to design the fishbone presentations.

Author information

Author notes

  1. M Seid and T L Byczkowski: MS was the consulting project statistician; TLB joined on the submission.

  2. S Kloman: On behalf of the California Children's Hospital Association-California Children's Services Neonatal Nosocomial Infection Prevention Project 2007 in association with the California Perinatal Quality Care Collaborative.

Authors and Affiliations

  1. David D Wirtschafter, MD, Inc., Valley Village, CA, USA

    D D Wirtschafter

  2. Doctors Medical Center, Modesto, CA, USA

    J Pettit

  3. Rady Children's Hospital San Diego, San Diego, CA, USA

    P Kurtin

  4. California Department of Health Care Services, Children's Medical Services Branch, Sacramento, CA, USA

    M Dalsey, K Chance & H W Morrow

  5. Divisions of Pulmonary Medicine and Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

    M Seid

  6. Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

    T L Byczkowski

  7. Thomas Patrick Advisors, San Francisco, CA, USA

    T P Huber

  8. University of California Davis Children's Hospital, University of California Davis Health System, Sacramento, CA, USA

    J M Milstein

  9. Miller Children's Hospital at Long Beach, Long Beach, CA, USA

    S M Bowles

  10. Children's Hospital Los Angeles, Los Angeles, CA, USA

    S Fichera

  11. University of California, San Francisco, UCSF Medical Center, San Francisco, CA, USA

    S Kloman

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  1. D D Wirtschafter
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  11. S M Bowles
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Corresponding author

Correspondence to D D Wirtschafter.

Appendix

Appendix

Multidisciplinary teams from participating hospitals

Children's Hospital Central California, Madera, CA:

Judie Spafford, RN, MSN; Gregg Pullen, MT(ASCP)M, RM(NRM), CIC; Krishkumar Rajani, MD; Stacie Venkatesan, RN, MSN

Children's Hospital Los Angeles, Los Angeles, CA:

Beverly Drummond, RN; Sharon Fichera, RNC, MSN, CNS, NNP; Janine Gaul, RNS, BSN; Lisa Kelly, MD

Children's Hospital Oakland. Oakland, CA:

Susie Adams, RN; David Durand, MD; Lily Labar, RN; Nick Mickas, MD; Teresa Proctor, NNP

Children's Hospital of Orange County, Orange, CA:

Vijay Dhar, MD; Helen Case, MA, RN; Linda Glenn, MN, RNC

Loma Linda University Children's Hospital, Loma Linda, CA:

Elba Fayard, MD; Debbie Hewitt, RN, MSN; Jean Newbold, RN, CNS, MS; Betsy Tan, RN, MS

Lucile Packard Children's Hospital at Stanford, Palo Alto, CA:

Karen Azevedo, RN; Heather Freeman, RN, MS; Bill Rhine, MD

Mattel Children's Hospital at UCLA, Los Angeles, CA:

Uday Devaskar, MD; Anahit Saringulian, RN, BSN, Pat Getzen, RN, BSN; Isabell Purdy, PhD, PNP, Marilyn Harris, RN, NNP, Anne McNeil, RN, BSN; Anne George, RN, BSN; Mary Alice Melwak PhD, PNP; Vladana Milisavljevic, MD

Miller Children's Hospital at Long Beach Memorial Medical Center, Long Beach, CA:

Susan Bowles, MSN, RNC; Leonel Guajardo, MD; Edward Reyes, RN, ICP; Mark Roberts, MD, CMO

Rady Children's Hospital and Health Center, San Diego, CA:

Peggy Grimm, RNC, MS; Barbara Lowe-Holt, RN, MBA; Mark Speziale, MD, PhD

Sutter Medical Center, Sacramento, CA:

Margaret Crockett, MSN, RN; Karen L. Semkiw, RN, MPA; Andrew Wertz, MD

University of California Davis Health System, Davis, CA:

Deborah Baker, MSN, RN; Joan Callao, RN; Patty Doolin, RN; Jeanette Harrison, MSN, RN; Jay Milstein, MD; Sherri Reese, RN, BSN, CIC

University of California Irvine, Irvine, CA:

Robin Koeppel, MS, RNC, CPNP, CNS; Nancy Lee, NNP; Kathleen Quan, RN, CIC, CPHQ; Cherry Uy, MD

University of California San Francisco Children's Hospital, San Francisco, CA:

Michelle Cathcart, RN; Steven Kloman, RN, CNS; Sally Sehring, MD

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Wirtschafter, D., Pettit, J., Kurtin, P. et al. A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections. J Perinatol 30, 170–181 (2010). https://doi.org/10.1038/jp.2009.172

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