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Decreasing infection in neonatal intensive care units through quality improvement
  1. J R Bowen1,2,
  2. I Callander3,4,
  3. R Richards5,
  4. K B Lindrea6
  5. for the Sepsis Prevention in NICUs Group
    1. 1Department of Neonatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
    2. 2Department of Obstetrics, Gynaecology and Neonatology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
    3. 3Department of Newborn Care, Liverpool Hospital, Sydney, New South Wales, Australia
    4. 4Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
    5. 5Neonatal Intensive Care Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
    6. 6School of Women's and Children's Health, Newborn Care Centre, Royal Hospital for Women, Sydney, New South Wales, Australia
    1. Correspondence to Dr J R Bowen, Department of Neonatology, Level 6, Clinical Services Building, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2016, Australia; jenny.bowen{at}


    Objective To decrease the incidence of bloodstream infection (BSI) for neonates <29 weeks gestation through quality improvement.

    Design Commencing in September 2011, eight neonatal intensive care units (NICUs) in New South Wales and Australian Capital Territory, Australia participated in the Sepsis Prevention in NICUs Group project, a multicentre quality improvement initiative to reduce neonatal infection through implementation of potentially better practices and development of teaching resources. Data were collected for neonates <29 weeks gestation from D3 to 35, using point of care data entry, for BSI, central line-associated BSI (CLABSI) and antibiotic use. Exponentially weighted moving average data trend lines for rates of BSI, CLABSI and antibiotic use for each NICU were automatically generated and composite charts were provided each month to participating NICUs.

    Results Between January 2012 and December 2014, data were collected from D3 to 35 for 1075 neonates <29 weeks gestation who survived >48 h, for a total of 33 933 bed days and 14 447 central line days. There was a significant decrease from 2012 to 2014 in BSI/1000 bed days (7.8±3.0 vs 3.8±1.1, p=0.000), CLABSI/1000 bed days (4.6±2.1 vs 2.1±0.8, p=0.003), CLABSI/1000 central line days (9.9±4.3 vs 5.4±1.7, p=0.012) and antibiotic days/100 bed days (31.1±4.3 vs 25.5±4.2, p=0.046).

    Conclusions This study demonstrates a >50% reduction in BSI in extremely premature neonates from D3 to 35 following a collaborative quality improvement project to reduce neonatal infection across an NICU network, supported by timely provision of data.

    • Neonate
    • Infection
    • Sepsis
    • CLABSI
    • Quality Improvement

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    • Collaborators NICU SPRING Group Members 2012–14: Centenary Hospital for Women and Children: Tejasvi Chaudhari. Children's Hospital, Westmead: Kaye Spence, Kathryn Carmo. John Hunter Children's Hospital: Chris Wake, Denise Kinross. Liverpool: Ian Callander (SPRING Database Developer), Robyn Richards, Doron Shein. Nepean: Barbara Jolley, Vijay Shingde, Ulrike Brandenburg. Royal Hospital for Women: Kwee Bee Lindrea (SPRING Co-Chair), Srinivas Bolisetti, Dianne Cameron. Royal North Shore Hospital: Jennifer Bowen (SPRING Chair), Sharan Bowers. Royal Prince Alfred Hospital: Adrienne Gordon, Sandie Bredemeyer, Jan Polverino. Sydney Children's Hospital: Mary Lou Morritt. Westmead Hospital: James Marceau, Marilyn Rochefort, Mark Tracy. NICUS: Barbara Bajuk, Sara Sedgley, Mark Leckie. PSN: Lynn Sinclair.

    • Contributors JRB was Chair of the SPRING group, analysed the data and wrote the first draft of the manuscript. IC was the Database Developer, extracted data from the database and facilitated the automated data feedback to NICUs. KBL was Co-chair of the SPRING group and coordinated production of the PICC insertion teaching video. RR and KBL developed the potentially better practices framework and supported NICU quality improvement activities. All authors contributed to interpretation of the data and have approved the final manuscript.

    • Competing interests None declared.

    • Ethics approval The NSW Population Health Services Research Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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