Dramatic Reduction in Neonatal Central-Line Associated Bloodstream Infections

May 8, 2015

Dramatic Reduction in Neonatal Central-Line Associated Bloodstream Infections

  1. F. Bruder Stapleton, MD

Results of an intensive, standardized approach to insertion and maintenance of central lines show that we can prevent neonatal CLABSI.

  1. F. Bruder Stapleton, MD

Central line–associated bloodstream infections (CLABSIs) are an important target in efforts to improve neonatal outcomes. A pediatric health system with eight neonatal intensive care units in both academic and community settings launched an initiative to intensify a previously established program to standardize insertion and maintenance of central lines in an effort to reduce CLABSIs. Interventions included a standard insertion bundle, a standard maintenance bundle, standard dressing changes, and a daily maintenance huddle with a checklist.

Results of these renewed CLABSI reduction efforts are below (the observation period was between 2007 and 2013 unless otherwise noted).

  • After 1 year of monitoring, aggregate bundle compliance increased to 90% and completion of daily catheter goal sheets was 95%.

  • Hand hygiene compliance exceeded 98% at the conclusion of the study.

  • CLABSI decreased from 6 per 1000 catheter-days at the end of 4 years of routine standardization to 1.43 per 1000 catheter-days after 5 months of intensified efforts (P<0.001) and decreased further to 0.68 after 2 more years.

  • An estimated 437 CLABSIs were avoided.

  • CLABSI events decreased from 63 to 6 per year.

  • All units had at least one year with no CLABSIs.

  • Total catheter-days decreased significantly.

Comment

An intensive, standardized prevention program made remarkable improvements in the reduction of neonatal CLABSI. Not only were infections prevented, but the number of catheter-use days was also reduced. We overuse central lines, which need exquisite management to prevent infections. But as these results show, it can be done.

Editor Disclosures at Time of Publication

  • Disclosures for F. Bruder Stapleton, MD at time of publication Editorial boards UpToDate

Citation(s):

Reader Comments (1)

R Barik,DNB Physician, Cardiology

This study verified the axiom/hypothesis "Health is in clean hand" .

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