RESUMEN
OBJECTIVE: The objective of this study was to reduce central line-associated blood stream infections (CLABSIs) among 13 collaborating regional neonatal intensive care units by 25%. We tested the hypothesis that change could be attributed to the quality improvement collaborative by testing for 'special cause' variation. STUDY DESIGN: Our prevention project included five features: (1) leadership commitment, (2) potentially best practices, (3) collaborative processes, (4) audit and feedback tools and (5) quality improvement techniques. Baseline (1 January 2006 to 30 August 2006) data were compared with the intervention (1 September 2006 to 30 June 2007) and post-intervention (1 July 2007 to 30 December 2007) periods and analyzed using statistical process control (SPC) methods. RESULT: We detected special cause variation, suggesting that the collaborative was associated with reduced infection rates, from 4.32 to 3.22 per 1000 line days (a 25% decrease) when comparing the baseline with the follow-up period. CONCLUSION: The collaborative's process was associated with fewer infections. SPC suggested that systematic changes occurred. The remaining challenges include sustaining or even further reducing the infection rate.
Asunto(s)
Bacteriemia/prevención & control , Cateterismo Venoso Central/normas , Infección Hospitalaria/prevención & control , Unidades de Cuidado Intensivo Neonatal , Evaluación de Procesos y Resultados en Atención de Salud , Garantía de la Calidad de Atención de Salud/métodos , California , Cateterismo Venoso Central/efectos adversos , Desinfección de las Manos/normas , Humanos , Recién NacidoRESUMEN
To examine differences in perinatal health among nine Asian ethnic subgroups, a descriptive epidemiological study was conducted using linked birth/infant death certificates for 1982 to 1987. When compared with Whites, Asians had a lower proportion of young mothers, unmarried mothers, and women who received first trimester prenatal care; a higher proportion of foreign-born mothers; and a different birthweight distribution. A great deal of heterogeneity was found in risk factors and infant mortality rates among the various Asian ethnic subgroups. Paradoxically, although Asian ethnic subgroups had a higher perinatal risk profile, they had more favorable birth outcomes than did Whites.
Asunto(s)
Asiático , Mortalidad Infantil , Adolescente , Adulto , Comparación Transcultural , Etnicidad , Femenino , Humanos , Recién Nacido , Embarazo , Resultado del Embarazo , Factores de Riesgo , Población BlancaRESUMEN
An outbreak of Neisseria meningitidis sero-group C disease occurred in four eighth grade students and in a younger sibling of another eighth grade student attending an intermediate school (seventh and eighth grades) in Santa Clara County, CA. Four cases had onset within 3 days in January, 1989, with the fifth case occurring approximately 10 days later. A case-control study was performed to determine risk factors associated with serogroup C meningococcal infection (disease or carriage) in this eighth grade class. Students were more likely to be infected if they had had a preceding viral-like respiratory illness characterized by fever (odds ratio (OR) 5.3, P = 0.03) or cough (OR 5.1, P = 0.048). A ski trip (OR 6.3, P = 0.01) and a poster-making session for a school dance (OR 3.7, P = 0.08) were identified as possible settings for a common exposure. Spending time with two specific students during lunchtime or outside of school was associated with an increased risk of infection (OR 7.0, P = 0.054; OR 5.8, P = 0.04).