Is zero central line-associated bloodstream infection rate sustainable? A 5-year perspective

Pediatrics. 2015 Jun;135(6):e1485-93. doi: 10.1542/peds.2014-2523. Epub 2015 May 18.

Abstract

Background and objective: Adoption and implementation of evidence-based measures for catheter care leads to reductions in central line-associated bloodstream infection (CLABSI) rates in the NICU. The purpose of this study is to evaluate whether this rate reduction is sustainable for at least 1 year and to identify key determinants of this sustainability at the NICU of the Floating Hospital for Children at Tufts Medical Center.

Methods: We reviewed the incidence of CLABSIs in the NICU temporally to the implementation of new practice policies and procedures, from July 2008 to December 2013.

Results: Adoption of standardized care practices, including bundles and checklists, was associated with a significant reduction of the CLABSI rate to zero for >370 consecutive days in our NICU in 2012. Overall, our CLABSI rates decreased from 4.1 per 1000 line days in 2009 (13 infections; 3163 line days) to 0.94 in 2013 (2 infections; 2115 line days), which represents a 77% reduction over a 5-year period. In the first quarter of 2013, there was a brief increase in CLABSI rate to 3.3 per 1000 line days; after a series of interventions, the CLABSI rate was maintained at zero for >600 days. Ongoing training, surveillance, and vigilance with catheter insertion and maintenance practices and improved documentation were identified as key drivers for success.

Conclusions: High-quality training, strict compliance with evidence-based guidelines, and thorough documentation is associated with significant reductions in CLABSIs. Mindful organizing may lead to a better understanding of what goes into a unit's ability to handle peak demands and sustain extraordinary performance in the long-term.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bacteremia / epidemiology
  • Bacteremia / etiology*
  • Bacteremia / prevention & control*
  • Catheter-Related Infections / epidemiology
  • Catheter-Related Infections / etiology*
  • Catheter-Related Infections / prevention & control*
  • Catheterization, Central Venous / adverse effects*
  • Guideline Adherence
  • Humans
  • Infant, Newborn
  • Time Factors