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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.
Shepherd EG et al. Significant reduction of central-line associated bloodstream infections in a network of diverse neonatal nurseries. J Pediatr 2015 Apr 24; [e-pub]. (http://dx.doi.org/10.1016/j.jpeds.2015.03.046)
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.