Significant Reduction of Central-Line Associated Bloodstream Infections in a Network of Diverse Neonatal Nurseries.
OBJECTIVE
To describe a quality improvement (QI) initiative that was associated with a dramatic reduction in neonatal central-line associated bloodstream infection (CLABSI) rate in a diverse group of 8 intensive care nurseries (Neonatal Services).


METHODS
A quasi-experimental time series QI initiative using the model for improvement and evidenced-based interventions.


RESULTS
The aggregate CLABSI rate for Nationwide Children's Hospital-associated Neonatal Services decreased from 6.0 CLABSI per 1000 catheter days to 1.43 CLABSI per 1000 catheter days in less than 2 years and has remained in control at 0.68 per 1000 catheter days for over 5 years. Each of 8 nurseries has had a 1 year or more CLABSI-free period, including the neonatal intensive care unit with the largest patient volume, acuity, and central line usage. Aggregate Neonatal Services has experienced 3 CLABSI-free quarters since 2007. Key success factors included: (1) engagement of senior executive leadership; (2) bedside "huddles" among clinical and epidemiology staffs conducted within 72 hours after a positive blood culture; (3) implementation of chlorhexidine antisepsis and the use of chlorhexidine-impregnated catheter site discs; and (4) and establishment of a dedicated team for percutaneously inserted central catheter insertion to serve units in which central lines are placed less frequently.


CONCLUSIONS
Using the model for improvement and evidenced-based interventions, this QI project has been associated with reduction in the CLABSI rate by 89%, and over 430 CLABSIs likely have been avoided.
Department of Pediatrics, The Ohio State University, Columbus, OH; Nationwide Children's Hospital, Columbus, OH.
Edward G
EG
Shepherd
Nationwide Children's Hospital, Columbus, OH.
Tami J
TJ
Kelly
Nationwide Children's Hospital, Columbus, OH.
Jodi A
JA
Vinsel
Department of Pediatrics, The Ohio State University, Columbus, OH; Nationwide Children's Hospital, Columbus, OH.
Dennis J
DJ
Cunningham
Nationwide Children's Hospital, Columbus, OH.
Erin
E
Keels
Nationwide Children's Hospital, Columbus, OH.
Wendi
W
Beauseau
Department of Pediatrics, The Ohio State University, Columbus, OH; Nationwide Children's Hospital, Columbus, OH. Electronic address: rick.mcclead@nationwidechildrens.org.
Richard E
RE
McClead
D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002710:Chlorhexidine / Q000627:therapeutic use; D054869:Clinical Audit; D004202:Disinfectants / Q000627:therapeutic use; D006235:Hand Disinfection; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000379:methods; D009725:Nurseries, Hospital; D009820:Ohio / Q000453:epidemiology; D010348:Patient Care Team; D058996:Quality Improvement
D004202:Disinfectants; D002710:Chlorhexidine