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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

Pediatric Critical Care Medicine: June 2013 - Volume 14 - Issue 5 - p 525–532
doi: 10.1097/PCC.0b013e31828a87cc
Quality and Safety

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.

1Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain.

2Faculty of Medicine, University of Barcelona, Barcelona, Spain.

3Critical Care Department, Mutua Terrassa University Hospital, Terrassa, Spain.

4CIBER Enfermedades Respiratorias, Madrid, Spain.

5Department of Medicine, Univeristy of Barcelona, Barcelona, Spain.

6Infection Control Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.

7Epidemiology and Assessment Unit, Fundació Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, Spain

*See also p. 551.

The authors have not disclosed any potential conflicts of interest.

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