David D Wirtschafter, MD, Inc., Valley Village, CA, USA.
J Perinatol. 2010 Mar;30(3):170-81. doi: 10.1038/jp.2009.172. Epub 2009 Nov 26.
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.
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.
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.
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.
本研究旨在通过 13 家合作的地区新生儿重症监护病房将中心静脉相关血流感染（CLABSIs）降低 25%。我们通过检测“特殊原因”变异来检验变化是否可以归因于质量改进协作，从而验证假设。
我们的预防项目包括五个特征：（1）领导力承诺，（2）潜在最佳实践，（3）协作过程，（4）审核和反馈工具，以及（5）质量改进技术。基线（2006 年 1 月 1 日至 2006 年 8 月 30 日）数据与干预期（2006 年 9 月 1 日至 2007 年 6 月 30 日）和干预后（2007 年 7 月 1 日至 2007 年 12 月 30 日）进行比较，并使用统计过程控制（SPC）方法进行分析。
我们检测到特殊原因变异，表明协作与感染率降低有关，从基线期的每千条线路 4.32 例降至随访期的每千条线路 3.22 例（降低 25%）。
协作的过程与感染减少有关。SPC 表明发生了系统性变化。剩余的挑战包括维持甚至进一步降低感染率。
