Bloom Barry T, Craddock Alyce, Delmore Paula M, Kurlinski John Parker, Voelker Mitch, Landfish Nancy, Rodriguez-Pierce Maria, Swanton Doug, Rossi Janet, Ehlen Jackie, Harmon Cindy, Deterding Julie, Houser Frank
Wesley Medical Center, 550 N. Hillside, Wichita, KS 67214, USA.
J Perinatol. 2003 Sep;23(6):489-92. doi: 10.1038/sj.jp.7210981.
Acquired infection is one of the most prevalent sources of concern in neonatal intensive care units (NICUs). Center-to-center variation has been noted by both the National Nosocomial Infection Surveillance System and the Vermont Oxford Network suggesting that site of care influences outcomes including acquired infection.
To reduce the acquired infection rate by isolating and then implementing meaningful process differences between high and low infection rate centers.
DESIGN/METHOD: A multistaged observation and intervention study. The primary outcome measure was defined as a positive blood culture, collected more than 3 days after birth. Hospital patient days along with infection episodes were collected for all NICU admissions in the network during the baseline and post-implementation periods. A detailed observation guide was used during site visits to high and low infection rate centers. The observations recorded in the guide allowed the team to isolate meaningful differences, which were shared with the network. Individual NICUs decided which of the meaningful differences, if any, to implement. To estimate the impact on costs, additional data were gathered in a case-matched series of infants in one demonstration site.
In all, 15 meaningful differences were isolated and shared with the network. The network rate for acquired infection dropped from 3.8 to 2.9 episodes per 1000 patient days. In the demonstration site, the infection rate dropped from 7.4 to 4.0 per 1000 patient days.
Isolation of process level differences between high and low performing centers followed by implementation of these meaningful differences may reduce acquired infections. Other targeted areas of care may benefit from this quality improvement methodology.
获得性感染是新生儿重症监护病房（NICU）中最普遍令人担忧的问题之一。国家医院感染监测系统和佛蒙特牛津网络都指出了中心之间存在差异，这表明护理地点会影响包括获得性感染在内的结果。
通过隔离并随后在高感染率和低感染率中心之间实施有意义的流程差异，以降低获得性感染率。
设计/方法：一项多阶段观察和干预研究。主要结局指标定义为出生3天后采集的血培养阳性。在基线期和实施期收集了网络中所有NICU入院患者的住院天数以及感染发作情况。在对高感染率和低感染率中心进行现场访问期间，使用了详细的观察指南。指南中记录的观察结果使团队能够找出有意义的差异，并与网络共享。各个NICU决定实施哪些有意义的差异（如果有的话）。为了评估对成本的影响，在一个示范地点对一系列病例匹配的婴儿收集了额外的数据。
总共找出了15个有意义的差异并与网络共享。获得性感染的网络发生率从每1000患者日3.8次降至2.9次。在示范地点，感染率从每1000患者日7.4次降至4.0次。
找出高绩效和低绩效中心之间流程层面的差异，然后实施这些有意义的差异，可能会减少获得性感染。其他有针对性的护理领域可能会从这种质量改进方法中受益。
