title: Is zero central line-associated bloodstream infection rate sustainable? A 5-year perspective.
abstract: OBJECTIVE
  Adoption and implementation of evidence-based measures for catheter care leads to reductions in central line-associated bloodstream infection (CLABSI) rates in the NICU. The purpose of this study is to evaluate whether this rate reduction is sustainable for at least 1 year and to identify key determinants of this sustainability at the NICU of the Floating Hospital for Children at Tufts Medical Center.
  
  
  METHODS
  We reviewed the incidence of CLABSIs in the NICU temporally to the implementation of new practice policies and procedures, from July 2008 to December 2013.
  
  
  RESULTS
  Adoption of standardized care practices, including bundles and checklists, was associated with a significant reduction of the CLABSI rate to zero for >370 consecutive days in our NICU in 2012. Overall, our CLABSI rates decreased from 4.1 per 1000 line days in 2009 (13 infections; 3163 line days) to 0.94 in 2013 (2 infections; 2115 line days), which represents a 77% reduction over a 5-year period. In the first quarter of 2013, there was a brief increase in CLABSI rate to 3.3 per 1000 line days; after a series of interventions, the CLABSI rate was maintained at zero for >600 days. Ongoing training, surveillance, and vigilance with catheter insertion and maintenance practices and improved documentation were identified as key drivers for success.
  
  
  CONCLUSIONS
  High-quality training, strict compliance with evidence-based guidelines, and thorough documentation is associated with significant reductions in CLABSIs. Mindful organizing may lead to a better understanding of what goes into a unit's ability to handle peak demands and sustain extraordinary performance in the long-term.
authors.affiliation: Division of Neonatology, Department of Pediatrics (Neonatology), Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; carmina.erdei@gmail.com.
authors.forename: Carmina
authors.initials: C
authors.lastname: Erdei
authors.affiliation: Division of Neonatology, Department of Pediatrics (Neonatology), Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts;
authors.forename: Linda L
authors.initials: LL
authors.lastname: McAvoy
authors.affiliation: Department of Pediatrics (Neonatology), Beth Israel Deaconess Medical Center, Boston, Massachusetts; and.
authors.forename: Munish
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Division of Neonatology, Department of Pediatrics (Neonatology), Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts;
authors.forename: Sunita
authors.initials: S
authors.lastname: Pereira
authors.affiliation: Department of Pediatrics (Neonatology), Women and Infants' Hospital, Providence, Rhode Island.
authors.forename: Elisabeth C
authors.initials: EC
authors.lastname: McGowan
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D013997:Time Factors