Program Schedule

Reducing Nosocomial Infection in the NICU: A report on the first 10 years of our Performance Improvement Journey in Honolulu

Session: Poster Abstract Session: MRSA and VRE
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Nosocomial infections are a major problem in Neonatal Intensive Care Units (NICU) that may cause death, disability, increase length of stay, decrease patient satisfaction, utilize medical center resources and generate increased costs.   Although, our NICU nosocomial infection rates compared favorably with contemporaneous rates in 2003, we were distressed with sharply defined time limited outbreaks of P. aeruginosa (PA), and S. aureus (SA) in our crowded open room 60 bed tertiary-care NICU.  Our project aim has been to decrease our nosocomial infection in a sustainable manner. 

Methods: We began our performance improvement following the Plan-Do-Check-Act cycle and involving many stakeholders.  This is a progress report on the first decade of our experience of the ongoing initiative including processes against nosocomial Blood Stream Infections (BSI), SA infections, NEC and Central Line Associated BSI (CLABSI). Universal daily mupirocin ointment to all NICU babies (2004), hand hygiene initiative (2005), PA environmental reduction initiative (2005), central line insertion bundle (2005), weekly survey and contact isolation for SA (2008), regular scheduled meetings with Infection Control and NICU MD and RN staff (2008), NEC prevention bundle (2008), dwell time limits for IV catheters (2008), comprehensive unit-based safety program (2009), central line maintenance bundle (2011). 

Results: Hand Hygiene rose: 60% 2005 to 96% 2012, p <.001, BSI fell from 9.6% admissions, 3.2/1000 patient days in 2003 to 0.5% admissions, 0.3/1000 patient-days in 2012.  All SA colonization and infections fell after mupirocin p <0.002.   NEC in <1500 g. babies declined 11% vs 4% p< 0.03.  CLABSI fell from 1.8/1000 line days 2010 to 0.18/1000 line days 2012. Major positive attitude changes and professional engagement accompanied these results.   A saving of $8,108,790 is estimated from the baseline period of 2003 through 2005 to the entire decade. 

Conclusion: We succeeded in reducing all bacteremias, all SA and PA infections, NEC, CLABSI. Our NICU nosocomial Infection rate and NEC rates are now in the lowest quartile of centers reporting to the Vermont Oxford Network. 


Marian Melish, MD, Kapiolani Medical Center for Women and Children, Honolulu, HI; University of Hawaii, Honolulu, HI and Guliz Erdem, MD, Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI


M. Melish, None

G. Erdem, None

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