Quality initiatives led to improvements in neonatal ICUs

Payne NR. Pediatrics. 2011;doi:10.1542/peds.2011-0566.

An initiative to improve quality in neonatal intensive care units led to reductions in nosocomial infections, according to study results published online.

Nathaniel R. Payne, MD, of the Children’s Hospital and Clinics of Minnesota, and colleagues reported data from a retrospective, observational study of the quality initiative. The intervention consisted of quality intervention team members meeting monthly to discuss issues and develop campus-specific interventions.

The data included information on infection rates in the 5 years before the initiative and the 3 years after.

The researchers said nosocomial infections decreased by half between the two groups, even among very low birth weight babies. The data also suggested reductions in “bronchopulmonary dysplasia (30.2% vs. 25.5%, P=.001), median days to regain birth weight (9 vs. 8, P=.04), percutaneously placed central venous catheter use (54.8% vs. 43.9%, P=.002), median antibiotic days (8 vs. 6, P=.003), median total central line days (16 vs. 15, P=.01), and median ventilator days (7 vs. 5, P=.01).”

The researchers said there were some limitations to their study; notably, that their hospital has participated in a number of quality improvement programs and, therefore, has “probably increased the receptivity of our staff to changing treatment processes.”

Regardless, they said their findings suggested these types of interventions offer promise to address quality control measures in hospitals.

Disclosure: The researchers report no relevant financial disclosures.

Samir S. Shah

Although recommendations for best practices to prevent infection exist, there are often systems-level barriers that make it more difficult for physicians and nurses to adhere to these recommendations. This study emphasized the importance of eliminating or minimizing systems-level barriers such as availability of supplies that made it much easier for practitioners to follow the appropriate guidelines and recommendations. Sometimes, changing the environment can be a key factor in improving adherence to best practices.

Another important aspect of this study was a clear emphasis on how clear demonstration of the organization's commitment to change can influence behavior. The publicity surrounding health care-acquired infection rates and the inclusion of paid time for education of nurses seemed to play a major role in overcoming the inertia of previous practice patterns.

For the daily practice of the hospital-based physician, I believe that this study provides proof, as well as inspiration, that adherence to proven multifaceted interventions, including attempts to demonstrate organizational commitment to change and removing systems-level barriers, can lead to sustained reductions in health care-acquired infections. Reduction of these infections was associated with overall improvements in patient outcomes.

Samir S. Shah, MD, MSCE
Infectious Diseases in Children Board Member

Disclosure: Dr. Shah reports no relevant financial disclosures.

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