title: Compliance with prevention practices and their association with central line-associated bloodstream infections in neonatal intensive care units.
abstract: BACKGROUND
  Bundles and checklists have been shown to decrease the rates of central line-associated bloodstream infections (CLABSIs), but implementation of these practices and association with CLABSI rates have not been described nationally. We describe implementation and levels of compliance with preventive practices in a sample of US neonatal intensive care units (NICUs) and assess their association with CLABSI rates.
  
  
  METHODS
  An online survey assessing infection prevention practices was sent to hospitals participating in National Healthcare Safety Network CLABSI surveillance in October 2011. Participating hospitals permitted access to their NICU CLABSI rates. Multivariable regressions were used to test the association between compliance with NICU-specific CLABSI prevention practices and corresponding CLABSI rates.
  
  
  RESULTS
  Overall, 190 level II/III and level III NICUs participated. The majority of NICUs had written policies (84%-93%) and monitored compliance with bundles and checklists (88%-91%). Reporting ≥95% compliance for any of the practices ranged from 50%-63%. Reporting of ≥95% compliance with insertion checklist and assessment of daily line necessity were significantly associated with lower CLABSI rates (P < .05).
  
  
  CONCLUSIONS
  Most of the NICUs in this national sample have instituted CLABSI prevention policies and monitor compliance, although reporting compliance ≥95% was suboptimal. Reporting ≥95% compliance with select CLABSI prevention practices was associated with lower CLABSI rates. Future studies should focus on identifying and improving compliance with effective CLABSI prevention practices in neonates.
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY. Electronic address: pz2177@cumc.columbia.edu.
authors.forename: Philip
authors.initials: P
authors.lastname: Zachariah
authors.affiliation: Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY; Department of Medicine, Columbia University Medical Center, New York, NY.
authors.forename: E Yoko
authors.initials: EY
authors.lastname: Furuya
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Edwards
authors.affiliation: RAND Corporation, Boston, MA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Dick
authors.affiliation: RAND Corporation, Boston, MA.
authors.forename: Hangsheng
authors.initials: H
authors.lastname: Liu
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York, NY.
authors.forename: Carolyn T A
authors.initials: CT
authors.lastname: Herzig
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York, NY.
authors.forename: Monika
authors.initials: M
authors.lastname: Pogorzelska-Maziarz
authors.affiliation: Center for Health Policy, Columbia University School of Nursing, New York, NY.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Stone
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY.
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D003625:Data Collection; D019983:Guideline Adherence; D006302:Health Services Research; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007363:Intensive Care Units, Neonatal; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology
keywords: Bundles; CLABSI; Neonate
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