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Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e31828a87cc
Quality and Safety

The Impact of a Quality Improvement Intervention to Reduce Nosocomial Infections in a PICU*

Esteban, Elisabeth MD1,2; Ferrer, Ricard MD, PhD3,4,5; Urrea, Mireya MD, PhD6; Suarez, David PhD7; Rozas, Librada RN6; Balaguer, Monica MD1,2; Palomeque, Antonio MD, PhD1,2; Jordan, Iolanda MD, PhD1,2

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Abstract

Objective: To evaluate whether a quality improvement intervention could reduce nosocomial infection rates in a PICU and improve patient outcomes.

Design: Prospective interventional cohort study conducted during three periods: preintervention period, intervention period, and long-term follow-up.

Setting: A 14-bed medical and surgical PICU in a university hospital for children.

Interventions: The quality improvement intervention consisted of the creation of an infection control team, a program targeting hand hygiene, and quality practices focused on preventing nosocomial infections.

Measurements and Main Results: We included 851 patients in the preintervention period, 822 in the intervention period, and 940 in the long-term follow-up period. Compared with the preintervention period, in the intervention period, the rates of central line–associated bloodstream infection decreased from 8.1 to 6/1,000 central venous catheter-days (p = 0.640), ventilator-associated pneumonia decreased from 28.3 to 10.6/1,000 days’ ventilation (p = 0.005), and catheter-associated urinary tract infection decreased from 23.3 to 5.8/1,000 urinary catheter-days (p < 0.001). Furthermore, hospital length of stay decreased from 18.56 to 14.57 days (p = 0.035) and mortality decreased from 5.1% to 3.3% (p = 0.056). Multivariable logistic regression found that nosocomial infections was independently associated with increased mortality (odds ratio, 2.35 [95% CI, 1.02–5.55]; p = 0.046). Compared with the preintervention period, in the long-term follow-up period, central line–associated bloodstream infection decreased to 4.6/1,000 central venous catheter-days (p = 0.205); ventilator-associated pneumonia decreased to 9.1/1,000 ventilation-days (p = 0.001), and catheter-associated urinary tract infection decreased to 5.2/1,000 urinary catheter-days (p < 0.001). Hospital length of stay (14.45 days; p = 0.048) and mortality (3.2%; p = 0.058) also decreased.

Conclusions: A multifaceted quality improvement intervention reduced nosocomial infection rates, hospital length of stay, and mortality in our PICU. The effects of the intervention were sustained over time.

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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