title: Reducing central line-associated bloodstream infections in North Carolina NICUs.
abstract: 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.
authors.affiliation: CAPT USN (Ret), Division of Neonatal-Perinatal Medicine, Department of Pediatrics, CB 7596, 4th Floor, UNC Hospitals, Chapel Hill, NC 27599-7596. martin_mccaffrey@med.unc.edu.
authors.forename: David
authors.initials: D
authors.lastname: Fisher
authors.forename: Keith M
authors.initials: KM
authors.lastname: Cochran
authors.forename: Lloyd P
authors.initials: LP
authors.lastname: Provost
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Patterson
authors.forename: Tara
authors.initials: T
authors.lastname: Bristol
authors.forename: Karen
authors.initials: K
authors.lastname: Metzguer
authors.forename: Brian
authors.initials: B
authors.lastname: Smith
authors.forename: Daniela
authors.initials: D
authors.lastname: Testoni
authors.forename: Martin J
authors.initials: MJ
authors.lastname: McCaffrey
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D057189:Checklist; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration / Q000592:standards*; D015931:Intensive Care, Neonatal / Q000379:methods / Q000592:standards*; D009657:North Carolina; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration*
keywords: CLABSI; central line–associated bloodstream infection; enteral feeding; family-centered care; infant; quality improvement