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Pediatrics. 2011 Mar;127(3):427-35. doi: 10.1542/peds.2010-2141. Epub 2011 Feb 21.

Ohio statewide quality-improvement collaborative to reduce late-onset sepsis in preterm infants.

Collaborators (173)

Firestone K, Kantak A, Ohlinger J, Beilstein L, Cannon C, Hray P, Pitts DL, Rossi E, Albert C, Douglass B, Kessler F, Mosnot J, Bondurant P, Burkhart C, Grisby C, Haberman B, Hershberger D, Baker J, Bennett C, DiNetto M, Eakins R, Gagliano G, Toth A, Beekman K, Jasin L, Link A, Morris J, Rone J, Bobek L, Dickey L, Kaser P, Pietz J, Speer D, Dudley J, Harris L, Nathan A, Potts C, Schibler K, Sherrod J, Levar S, Schwersenski J, Shirey S, Walton C, Collin M, Fundzak M, Mhanna M, Belcastro M, Mackey S, Morrison T, Ahmed E, Garrett M, LaJeunesse D, Lombardo T, Notestine J, Sturges K, Beverly J, Conte S, Meyers M, Miller R, Peeples A, Snyder G, Garrett M, Halpern B, Johnson M, Shade L, Bagwell G, Gest A, Hitchner J, Kelly T, Lowe J, Miller R, Sutton J, Taylor R, Malleske D, Stafford S, Holston M, Kuehne B, Naik A, Jaeger C, Kennedy K, Wall P, Aouthmany MM, Roe J, Samples P, Bold JZ, Flohr T, Frantz K, Grow J, Seiber D, Biggs S, Cordero L, Jenkins C, Popa M, Sweet M, Taylor D, Chappell B, Fritz D, Gall V, Gresky J, Moore M, Ruff J, Stein H, Croop L, Narendran V, Rosenberg E, Capper B, Deakins K, Fanaroff J, Haas K, Jawdeh EA, Lewis T, Reitenbach A, Seekely A, Walsh M, Applegate M, Bagwell G, Bailit J, Belcastro M, Bouchard J, Chappell B, Christopher B, Deacon L, Donovan E, Friar K, Gest A, Heinrich P, Hughes K, Iams J, Kantak A, Kaplan H, Keller K, Lannon C, Marcotte M, McClead R, McKenna D, Mercer B, Rose B, Strafford C, Swank MA, Walsh M, Bouchard J, Deacon L, Friar K, Hughes K, Kassouf M, Paulson J, Wargo B, Applegate M, Keller K, Clement Saxe D, Carpenter J, Cloutier N, Horbar J, Krieder T, Leahy K, Stillman AL, Warner P, Hill K, Swank MA, Fritz D, Ferguson CF, Benjamin M, Orosz J, Teal C, Atherton H, Besl J, Christopher R, McClendon D, Rose B, Salvage T, Sam S, Short KM, Mariea Taylor M.

Author information

Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229, USA.



We aimed to reduce late-onset bacterial infections in infants born at 22 to 29 weeks' gestation by using collaborative quality-improvement methods to implement evidence-based catheter care. We hypothesized that these methods would result in a 50% reduction in nosocomial infection.


We conducted an interrupted time-series study among 24 Ohio NICUs. The intervention began in September 2008 and continued through December 2009. Sites used the Institute for Healthcare Improvement Breakthrough Series quality-improvement model to facilitate implementation of evidence-based catheter care. Data were collected monthly for all catheter insertions and for at least 10 observations of indwelling catheter care. NICUs also submitted monthly data on catheter-days, patient-days, and episodes of infection. Data were analyzed by using statistical process control methods.


During the intervention, NICUs submitted information on 1916 infants. Of the 242 infections reported, 69% were catheter associated. Compliance with catheter-insertion components was >90% by April 2009. Compliance with components of evidence-based indwelling catheter care reached 80.4% by December 2009. There was a significant reduction in the proportion of infants with at least 1 late-onset infection from a baseline of 18.2% to 14.3%.


There was a 20% reduction in the incidence of late-onset infection after the intervention, but the magnitude was less than hypothesized, perhaps because compliance with components of evidence-based care of indwelling catheters remained <90%. Because nearly one-third of infections were not catheter associated, improvement may require attention to other aspects of care such as skin integrity and nutrition.

[Indexed for MEDLINE]

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