1. From 2007 to 2011, major elements of the initiative included: Two statewide meetings per year; Transparent sharing of infection rates from each NICU; Comparative performance reports by NICU twice yearly; and Practice surveys to identify differences in practices. From 2012 to 2013, we joined the national NCABSI project, with 7 out of 10 NICUs participating. This project included: Standardized insertion and maintenance checklists; and Culture of safety training. In 2014, the project entered a sustainment phase focused on ongoing distribution of biannual hospital performance reports. Reduction of Neonatal Nosocomial Infections through a Statewide Collaborative Munish Gupta (BIDMC) and Alan Picarillo (UMass), for the Neonatal Quality Improvement Collaborative of Massachusetts (NeoQIC) Reduction of Neonatal Nosocomial Infections through a Statewide Collaborative Munish Gupta (BIDMC) and Alan Picarillo (UMass), for the Neonatal Quality Improvement Collaborative of Massachusetts (NeoQIC) In 2006, the ten level III neonatal intensive care units (NICUs) in the state formed the Neonatal Quality Improvement Collaborative of Massachusetts (NeoQIC), with the mission of using open sharing of data and practices to improve neonatal outcomes. NICU infants, particularly very-low birth weight (VLBW) infants, are at high risk for nosocomial infection. Substantial experience has shown that quality improvement (QI) efforts can significantly lower the rate of nosocomial infections, particularly central-line associated bloodstream infections (CLABSI), in NICUs. Sustaining these improvements has proven more challenging, as many centers have reported an increase in infection after QI initiative was completed. Our first project in NeoQIC focused on nosocomial infections and launched in 2007. The project is currently in sustainment. NeoQIC NICUs care for approximately 700-800 VL BW infants and utilize approximately 18,000 central line days per year. Background Interventions Results The Team All 10 level III NICUs in the state are participating. Tools Lessons Learned Collaborative QI methods utilizing open and transparent sharing of data and practices to support local QI efforts may have contributed to significant reductions in infection rates in NeoQIC NICUs. This initiative was built on local improvement work and collaboration, without need for substantial new funding. Improvements have persisted into sustainment phase of project, suggesting efforts during the active phase may have led to sustained changes in practice. Next Steps Ongoing monitoring of infection rates with biannual hospital performance reports Ongoing monitoring of line care practices, including use of insertion and maintenance checklists, to assess changes in practice New initiative launched in 2015 focused in human milk use in VLBW infants with goal of further reduction in nosocomial infection rates Example of Differences from Practice Survey Example of Comparative Infection Report Sample Page from Hospital Performance Report Selected Process Measures Data from NCABSI project (7/10 NICUs) Trends towards shorter line duration and increased compliance with maintenance checklists Outcome Measures Any late infection in VLBW infants (9/10 NICUs) CLABSI in all NICU infants (10/10 NICUs) Over 60% reduction in infection rates

2. Participating centers, NeoQIC Noscomial Infection Project