title: A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit.
abstract: OBJECTIVE
  To reduce the rate of late-onset sepsis in a neonatal intensive care unit (NICU) by decreasing the rate of central line-associated bloodstream infection (CLABSI).
  
  
  METHODS
  We conducted a quasi-experimental study of an educational intervention designed to improve the quality of clinical practice in an NICU. Participants included all NICU patients with a central venous catheter (CVC). Data were collected during the period from July 1, 2005, to June 30, 2007, to document existing CLABSI rates and CVC-related practices. A multidisciplinary quality improvement committee was established to review these and published data and to create guidelines for CVC placement and management. Educational efforts were conducted to implement these practices. Postintervention CLABSI rates were collected during the period from January 1, 2008, through March 31, 2009, and compared with preintervention data and with benchmark data from the National Healthcare Safety Network (NHSN).
  
  
  RESULTS
  The rate of CLABSI in the NICU decreased from 8.40 to 1.28 cases per 1,000 central line-days (adjusted rate ratio, 0.19 [95% confidence interval, 0.08-0.45]). This rate was lower than the NHSN benchmark rate for level III NICUs. The overall rate of late-onset sepsis was reduced from 5.84 to 1.42 cases per 1,000 patient-days (rate difference, -4.42 cases per 1,000 patient-days [95% confidence interval, -5.55 to -3.30 cases per 1,000 patient-days]).
  
  
  CONCLUSIONS
  It is possible to reduce the rate of CLABSI, and therefore the rate of late-onset sepsis, by establishing and adhering to evidence-based guidelines. Sustainability depends on continued data surveillance, knowledge of medical and nursing literature, and timely feedback to the staff. The techniques established are applicable to other populations and areas of inpatient care.
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA. matthew.bizzarro@yale.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bizzarro
authors.forename: Barbara
authors.initials: B
authors.lastname: Sabo
authors.forename: Melanie
authors.initials: M
authors.lastname: Noonan
authors.forename: Mary-Pat
authors.initials: MP
authors.lastname: Bonfiglio
authors.forename: Veronika
authors.initials: V
authors.lastname: Northrup
authors.forename: Karen
authors.initials: K
authors.lastname: Diefenbach
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D003237:Connecticut / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000458:organization & administration*; D007363:Intensive Care Units, Neonatal; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000458:organization & administration