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The power of improvement
  1. Roger F Soll1,
  2. William H Edwards2
  1. 1Department of Pediatrics, The University of Vermont College of Medicine, Burlington, Vermont, USA
  2. 2Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
  1. Correspondence to Professor Roger F Soll, Department of Pediatrics, University of Vermont Medical Center, 111 Colchester Ave., Burlington, VT 05401, USA; roger.soll{at}

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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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  • Contributors Both WHE and RFS contributed to the content and editing of the attached commentary.

  • Competing interests RFS and WHE are members of the Board of Directors of the Vermont Oxford Network.

  • Provenance and peer review Commissioned; internally peer reviewed.

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