Significant Reduction of Central-Line Associated Bloodstream Infections in a Network of Diverse Neonatal Nurseries

J Pediatr. 2015 Jul;167(1):41-6.e1-3. doi: 10.1016/j.jpeds.2015.03.046. Epub 2015 Apr 25.


Objective: To describe a quality improvement (QI) initiative that was associated with a dramatic reduction in neonatal central-line associated bloodstream infection (CLABSI) rate in a diverse group of 8 intensive care nurseries (Neonatal Services).

Study design: A quasi-experimental time series QI initiative using the model for improvement and evidenced-based interventions.

Results: The aggregate CLABSI rate for Nationwide Children's Hospital-associated Neonatal Services decreased from 6.0 CLABSI per 1000 catheter days to 1.43 CLABSI per 1000 catheter days in less than 2 years and has remained in control at 0.68 per 1000 catheter days for over 5 years. Each of 8 nurseries has had a 1 year or more CLABSI-free period, including the neonatal intensive care unit with the largest patient volume, acuity, and central line usage. Aggregate Neonatal Services has experienced 3 CLABSI-free quarters since 2007. Key success factors included: (1) engagement of senior executive leadership; (2) bedside "huddles" among clinical and epidemiology staffs conducted within 72 hours after a positive blood culture; (3) implementation of chlorhexidine antisepsis and the use of chlorhexidine-impregnated catheter site discs; and (4) and establishment of a dedicated team for percutaneously inserted central catheter insertion to serve units in which central lines are placed less frequently.

Conclusions: Using the model for improvement and evidenced-based interventions, this QI project has been associated with reduction in the CLABSI rate by 89%, and over 430 CLABSIs likely have been avoided.

MeSH terms

  • Bacteremia / epidemiology
  • Bacteremia / prevention & control*
  • Catheter-Related Infections / epidemiology
  • Catheter-Related Infections / prevention & control*
  • Catheterization, Central Venous / adverse effects*
  • Chlorhexidine / therapeutic use
  • Clinical Audit
  • Disinfectants / therapeutic use
  • Hand Disinfection
  • Humans
  • Infant, Newborn
  • Infection Control / methods*
  • Intensive Care Units, Neonatal*
  • Intensive Care, Neonatal / methods
  • Nurseries, Hospital
  • Ohio / epidemiology
  • Patient Care Team
  • Quality Improvement*


  • Disinfectants
  • Chlorhexidine