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

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. Journal of Perinatology ( 2010) 30, 170-181; doi:10.1038/jp.2009.172; published online 26 November 2009