Successful reduction in central line-associated bloodstream infections in a Chinese neonatal intensive care unit.
BACKGROUND
Few data are available on central-line associated bloodstream infections (CLABSIs) in Chinese neonatal intensive care units (NICUs). The aims of this study were to characterize CLABSIs among neonates in a Chinese NICU and evaluate the impact of a multifaceted evidence-based practice for improving quality program to decrease CLABSI.


METHODS
We conducted a prospective before-after intervention study with a 1-year follow-up among patients with central lines at the NICU of the Children's Hospital of Fudan University between January 2008 and December 2010. The study was conducted in 3 phases: before, during, and after the intervention. A multifaceted infection control program was introduced in phase 2 with successive surveillance. CLABSIs were prospectively monitored and compared.


RESULTS
A total of 171 patients with central lines (CLs) were observed; 29 of them developed CLABSI corresponding to 7.35 per 1,000 catheter days, with a CL utilization ratio of 37.9%. Overall CLABSI rate decreased gradually from 16.7 per 1,000 CL days in phase 1 to 7.6 per 1,000 CL days in phase 2 (P = .08) to 5.2 per 1,000 CL days in phase 3 (P < .01). Gram-negative bacterium (54.5%) was the predominant pathogen in CLABSIs.


CONCLUSIONS
A multifaceted infection control program is effective in reducing the CLABSI rate among neonates. Such interventions could be extended to other resource-limited countries.
Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
Qi
Q
Zhou
Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
Shoo K
SK
Lee
Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
Xiao-jing
XJ
Hu
Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
Si-yuan
SY
Jiang
Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
Chao
C
Chen
Department of Microbiology, Children's Hospital of Fudan University, Shanghai, China.
Chuan-qing
CQ
Wang
Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China. Electronic address: yuncaochina@hotmail.com.
Yun
Y
Cao
D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007363:Intensive Care Units, Neonatal; D008297:Male; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control*
Central line; Health care–associated infections; Infant; Practice change