A Quality Improvement Program to Reduce Central Line Associated Blood Stream Infections in Neonates

Abstract

Introduction: Late onset sepsis is a common problem among neonatal intensive care unit (NICU) population with central venous catheter (CVC) being the primary source of infection in the majority of the cases. Central line associated bloodstream infections (CLABSIs) have been significantly reduced by care bundles implanted in NICUs. This study is conducted to detect the overall CLABSI rate, by comparing the rate per 1000 line days in the pre-intervention to that in the post-intervention periods, to prove that change could be attributed to the quality improvement bundles. Methods: This was a retrospective observational study. It included all patients with central line inserted at NICU of MGH from January 2012 to February 2014 and compared these patients with historical cohort from 22 months of 2010 and 2011. Specific interventions were designed for the central line related practices. Specific interventions according to CDC recommendations emphasize best practices in all areas of central line care: reduction of line entries, aseptic entries into the line, and aseptic procedures when changing line components. Results: Overall, CLABSI rates, in our NICU, declined significantly by 57.3% from 15 CLABSI per 1000 central line days in the pre-intervention period to 6.4 CLABSI in 1000 central line days in the post-intervention period (P<0.05). Significant reductions in CLABSI rates were noted for neonates with birth weight less than <1000g and neonates between 1001 g and 1500 g during the post-intervention period, compared with the CLABSI rates for neonates from pre-intervention period. Conclusion: We found that our efforts didn’t result in a decrease in the use of CVC among neonates. Hence, central line utilization rate was not associated, in our study, with CLABSI risk. Our quality improvement effort was successful in significantly reduced CLABSI rates. The majority of our success can be linked to educational efforts based on pertinent and timely data and literature.