Reducing central line-associated bloodstream infections in North Carolina NICUs.
Journal Article
OBJECTIVE: Central lines in NICUs have long dwell times. Success in reducing central line-associated bloodstream infections (CLABSIs) requires a multidisciplinary team approach to line maintenance and insertion. The Perinatal Quality Collaborative of North Carolina (PQCNC) CLABSI project supported the development of NICU teams including parents, the implementation of an action plan with unique bundle elements and a rigorous reporting schedule. The goal was to reduce CLABSI rates by 75%. METHODS: Thirteen NICUs participated in an initiative developed over 3 months and deployed over 9 months. Teams participated in monthly webinars and quarterly face-to-face learning sessions. NICUs reported on bundle compliance and National Health Surveillance Network infection rates at baseline, during the intervention, and 3 and 12 months after the intervention. Process and outcome indicators were analyzed using statistical process control methods (SPC). RESULTS: Near-daily maintenance observations were requested for all lines with a 68% response rate. SPC analysis revealed a trend to an increase in bundle compliance. We also report significant adoption of a new maintenance bundle element, central line removal when enteral feedings reached 120 ml/kg per day. The PQCNC CLABSI rate decreased 71%, from 3.94 infections per 1000 line days to 1.16 infections per 1000 line days with sustainment 1 year later (P = .01). CONCLUSIONS: A collaborative structure targeting team development, family partnership, unique bundle elements and strict reporting on line care produced the largest reduction in CLABSI rates for any multiinstitutional NICU collaborative.
Full Text
Duke Authors
Cited Authors
- Fisher, D; Cochran, KM; Provost, LP; Patterson, J; Bristol, T; Metzguer, K; Smith, B; Testoni, D; McCaffrey, MJ
Published Date
- December 2013
Published In
Volume / Issue
- 132 / 6
Start / End Page
- e1664 - e1671
PubMed ID
- 24249819
Pubmed Central ID
- 24249819
Electronic International Standard Serial Number (EISSN)
- 1098-4275
Digital Object Identifier (DOI)
- 10.1542/peds.2013-2000
Language
- eng
Conference Location
- United States