CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTION REDUCTION IN THE NEONATAL INTENSIVE CARE UNIT: A QUALITY IMPROVEMENT PROJECT

Central Line Blood Stream Infection (CLABSI) in the Neonatal Intensive Care Unit (NICU) remains a serious health care issue. Although CLABSI reductions have been reported in both the pediatric and adult populations primarily through application of evidence-based practices, research-proven CLABSI reduction practices for the patient in the NICU is lacking. Patients in the NICU are at high risk for CLABSI due to their immature biological systems and need for long-term central line access. Recent reports from multiple learning collaboratives as well as single institutions have demonstrated significant reduction of CLABSI in the NICU. Sustainment of these early successes beyond the initial implementation period has not been widely reported. Although Quality improvement (QI) projects may have initial successes in improving care; very few projects are designed to measure success over time or identify important key factors associated with sustained improvements. Identifying factors associated with improvement sustainment is gaining increased attention across healthcare settings and a much needed next step for optimal patient outcomes. This single-center QI project evaluated the effect of CLABSI reduction efforts on CLABSI rates over 11-years. All infants admitted to the 45-NICU between 2004 and 2014 who required a central line were included in the project. A steady decline in CLABSI rate was demonstrated. During the sustainment phase of the project (2010- 2014), the annual CLABSI rate was reduced by 92% (8.67 vs. 0.65/1000 line days) over iv baseline showing a continuing decline beyond the 40% reduction during the intervention phase. CLABSI rate reductions were associated with important key factors including use of closed infusion systems, reducing central line entries, review and evaluation of events leading to a positive blood culture, regular and ongoing central line insertion and maintenance process audits, and clear and timely communication of QI efforts and results (posting of days-between-CLABSIs, for example) to all health care providers