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Am J Perinatol 2017; 34(10): 1032-1040
DOI: 10.1055/s-0037-1601563
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Teamwork in the NICU Setting and Its Association with Health Care–Associated Infections in Very Low-Birth-Weight Infants

Jochen Profit
1   Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California
2   California Perinatal Quality Care Collaborative, Palo Alto, California
,
Paul J. Sharek
2   California Perinatal Quality Care Collaborative, Palo Alto, California
3   Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, California
4   Division of Hospitalist Medicine, Department of Pediatrics, Stanford University, Palo Alto, California
,
Peiyi Kan
5   Department of Pediatrics Research and Statistical Unit, Stanford University, Palo Alto, California
,
Joseph Rigdon
6   Quantitative Sciences Unit, Department of Pediatrics, Stanford University, Palo Alto, California
,
Manisha Desai
6   Quantitative Sciences Unit, Department of Pediatrics, Stanford University, Palo Alto, California
,
Courtney C. Nisbet
2   California Perinatal Quality Care Collaborative, Palo Alto, California
4   Division of Hospitalist Medicine, Department of Pediatrics, Stanford University, Palo Alto, California
,
Daniel S. Tawfik
7   Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California
,
Eric J. Thomas
8   University of Texas at Houston–Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School, Houston
,
Henry C. Lee
1   Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California
2   California Perinatal Quality Care Collaborative, Palo Alto, California
,
J. Bryan Sexton
9   Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham
10   Duke Patient Safety Center, Duke University Health System, Durham
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Publikationsverlauf

06. Oktober 2016

25. Februar 2017

Publikationsdatum:
10. April 2017 (online)

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Abstract

Background and Objective Teamwork may affect clinical care in the neonatal intensive care unit (NICU) setting. The objective of this study was to assess teamwork climate across NICUs and to test scale-level and item-level associations with health care–associated infection (HAI) rates in very low-birth-weight (VLBW) infants.

Methods Cross-sectional study of the association between HAI rates, defined as any bacterial or fungal infection during the birth hospitalization, among 6,663 VLBW infants cared for in 44 NICUs between 2010 and 2012. NICU HAI rates were correlated with teamwork climate ratings obtained in 2011 from 2,073 of 3,294 eligible NICU health professionals (response rate 63%). The relation between HAI rates and NICU teamwork climate was assessed using logistic regression models including NICU as a random effect.

Results Across NICUs, 36 to 100% (mean 66%) of respondents reported good teamwork. HAI rates were significantly and independently associated with teamwork climate (odds ratio, 0.82; 95% confidence interval, 0.73–0.92, p = 0.005), such that the odds of an infant contracting a HAI decreased by 18% with each 10% rise in NICU respondents reporting good teamwork.

Conclusion Improving teamwork may be an important element in infection control efforts.

Keywords

infant - newborn - teamwork - safety culture - neonatal intensive care unit - infection

Author Contributions

Drs. Profit and Sexton had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.


Individual author contributions:


 ICMJE criteria for authorship read and met: J.P., P.J.S., J.R., M.D., C.C.N., E.J.T., H.C.L., and J.B.S.


 Agree with the article's results and conclusions: J.P., P.J.S., M.B., J.R., M.D., C.C.N., E.J.T., H.C.L., and J.B.S.


 Designed the experiments/the study: J.P., M.B., H.C.L., and J.B.S.


 Analyzed the data: P.K., M.B., J.B.S.


 Wrote the first draft of the article: J.P., J.B.S.


 Assisted with approach and selection of data inputs: J.P., P.J.S., E.J.T., H.C.L., and J.B.S.


 Assisted with the interpretation of results: J.P., P.J.S., M.B., J.R., M.D., C.C.N., E.J.T., H.C.L., and J.B.S.


 Contributed to the revision of the article: J.P., P.J.S., M.B., J.R., M.D., D.S.T., C.C.N., E.J.T., H.C.L., and J.B.S.