title: Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists.
abstract: OBJECTIVE
  In 2008, all 18 regional referral NICUs in New York state adopted central-line insertion and maintenance bundles and agreed to use checklists to monitor maintenance-bundle adherence and report checklist use. We sought to confirm whether adopting standardized bundles and using central-line maintenance checklists reduced central-line-associated bloodstream infections (CLABSI).
  
  
  METHODS
  This was a prospective cohort study that enrolled all neonates with a central line who were hospitalized in any of 18 NICUs. Each NICU reported CLABSI and central-line utilization data and checklist use. We used χ(2) to compare CLABSI rates in the preintervention (January to December 2007) versus the postintervention (March to December 2009) periods and Poisson regression to model adjusted CLABSI rates.
  
  
  RESULTS
  Each study period included more than 55 000 central-line days and more than 200 000 patient-days. CLABSI rates decreased 67% statewide (risk ratio: 0.33 [95% confidence interval: 0.27-0.41]; P < .0005); after adjusting for the altered central-line-associated bloodstream infection definition in 2008, by 40% (risk ratio: 0.60 [95% confidence interval: 0.48-0.75]; P < .0005). A total of 13 of 18 NICUs reported using maintenance checklists for 10% to 100% of central-line days. The checklist-use rate was associated with the CLABSI rate (coefficient: -0.57, P = .04). A total of 10 of 18 NICUs were independent CLABSI rate predictors, ranging from 1 site with greatly reduced risk (incidence rate ratio: 0.04, P < .0005) to 1 site with greatly increased risk (incidence rate ratio: 2.87, P < .0005).
  
  
  CONCLUSIONS
  Although standardizing central-line care elements led to a significant statewide decline in NICU CLABSIs, site of care remains an independent risk factor. Using maintenance checklists reduced CLABSIs.
authors.affiliation: Weill Medical College, Cornell University, Pediatrics/Newborn Medicine, 525 East 68th St, Box 106, New York, New York 10021, USA. jos2039@med.cornell.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Schulman
authors.forename: Rachel
authors.initials: R
authors.lastname: Stricof
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Stevens
authors.forename: Michael
authors.initials: M
authors.lastname: Horgan
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gase
authors.forename: Ian R
authors.initials: IR
authors.lastname: Holzman
authors.forename: Robert I
authors.initials: RI
authors.lastname: Koppel
authors.forename: Suhas
authors.initials: S
authors.lastname: Nafday
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gibbs
authors.forename: Robert
authors.initials: R
authors.lastname: Angert
authors.forename: Aryeh
authors.initials: A
authors.lastname: Simmonds
authors.forename: Susan A
authors.initials: SA
authors.lastname: Furdon
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000517:prevention & control; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D057189:Checklist; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D009518:New York / Q000453:epidemiology; D011446:Prospective Studies; D019984:Quality Indicators, Health Care