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Davis et al1 report on a quality improvement project aimed at reducing bloodstream infections in the neonatal intensive care unit (NICU) and evaluating the long-term consequences of such a project. They introduced an infection reduction bundle in a tertiary care neonatal unit in the UK. Baseline rates before were relatively high compared with other standards; the reported rate from the unit in Bristol was 40% compared with a mean rate in the Vermont Oxford Network (VON) of 20%.
The quality improvement strategy included assembling a multidisciplinary team to implement and monitor successful introduction of a fairly standard set of potentially better practices. Reduction in the incidence of nosocomial sepsis due to coagulase-negative staphylococci was the primary outcome, although sepsis due to other late bacterial pathogens as well as other outcomes was assessed. An important contribution of this study was a commitment to gather long-term neurodevelopmental outcomes.
A total of 757 patients were born during the two study periods. The rates of coagulase-negative Staphylococcus infections were significantly reduced (26.7%–14.1%) as were the rates of late bacterial infection (18.8%–8.7%). Death prior to discharge was reduced, but did not reach statistical significance. The rates of cognitive disability were noted to be reduced in the postintervention cohort (18.8% vs 6.1%), and while significant in the univariate analysis, failed to reach statistical significance in the multivariate analysis.
The impressive quality improvement work by Davis et al took …
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