title: Significant Reduction of Catheter-associated Blood Stream Infections in Preterm Neonates After Implementation of a Care Bundle Focusing on Simulation Training of Central Line Insertion.
abstract: BACKGROUND
  Central line-associated blood stream infections (CLABSIs) are common problems in neonatal intensive care units (NICUs). Implementation of catheter care bundles has been shown to reduce CLABSI rates. We developed a care bundle aiming at establishing a uniform central line insertion technique and improving teaching practices focusing on simulation-based techniques. The purpose of this study was to assess the impact of this care bundle on CLABSI rates in very low birth weight infants (VLBWI).
  
  
  METHODS
  In September 2010, a CLABSI prevention bundle was introduced in our NICU, consisting of simulation-based standardization and education of a peripherally inserted central catheter insertion technique. Data of all VLBWI admitted to our NICU during 2010-2012 were analyzed. Diagnosis of CLABSI required a positive blood culture in the presence of a central venous catheter and clinical signs of infection.
  
  
  RESULTS
  Five hundred twenty-six VLBWI admitted during the study period were included into the analysis. CLABSI rates decreased significantly from 13.9 in 2010 to 9.5 in 2011 and 4.7 in 2012 (P < 0.0001). This significant reduction was true for the overall population and for subgroups separated by birth weight. Distribution of blood culture pathogens revealed a constant absolute and relative decline of infections with coagulase-negative staphylococci from 2010 (n = 43/50, 86%) to 2012 (n = 12/18, 67%), as opposed by a slight increase of Staphylococcus aureus infections (n = 1/50, 2% in 2010 versus n = 2/18, 11% in 2012).
  
  
  CONCLUSIONS
  Our data provide evidence of a potential effect of simulation-based training of central line placement in decreasing CLABSI rates in VLBWI and encourage its implementation into care bundles.
authors.affiliation: From the *Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna; and †Department of Epidemiology, Center of Public Health, Medical University of Vienna, Vienna, Austria.
authors.forename: Manuel
authors.initials: M
authors.lastname: Steiner
authors.forename: Michaela
authors.initials: M
authors.lastname: Langgartner
authors.forename: Francesco
authors.initials: F
authors.lastname: Cardona
authors.forename: Thomas
authors.initials: T
authors.lastname: Waldhör
authors.forename: Jens
authors.initials: J
authors.lastname: Schwindt
authors.forename: Nadja
authors.initials: N
authors.lastname: Haiden
authors.forename: Angelika
authors.initials: A
authors.lastname: Berger
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000517:prevention & control; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009359:Neonatology / Q000193:education / Q000379:methods / Q000592:standards; D064872:Patient Care Bundles / Q000706:statistics & numerical data*; D047928:Premature Birth