title: SLUG Bug: Quality Improvement With Orchestrated Testing Leads to NICU CLABSI Reduction.
abstract: OBJECTIVE
  Reduce central line-associated bloodstream infection (CLABSI) rates 15% over 12 months in children's hospital NICUs. Use orchestrated testing as an approach to identify important CLABSI prevention practices.
  
  
  METHODS
  Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for central line care. Four existing CLABSI prevention strategies (tubing change technique, hub care monitoring, central venous catheter access limitation, and central venous catheter removal monitoring) were identified for study. We compared the change in CLABSI rates from baseline throughout the study period in 17 participating centers. Using orchestrated testing, centers were then placed into 1 of 8 test groups to identify which prevention practices had the greatest impact on CLABSI reduction.
  
  
  RESULTS
  CLABSI rates decreased by 19.28% from 1.333 to 1.076 per 1000 line-days. Six of the 8 test groups and 14 of the 17 centers had decreased infection rates; 16 of the 17 centers achieved >75% compliance with process measures. Hub scrub compliance monitoring, when used in combination with sterile tubing change, decreased CLABSI rates by 1.25 per 1000 line-days.
  
  
  CONCLUSIONS
  This multicenter improvement collaborative achieved a decrease in CLABSI rates. Orchestrated testing identified infection prevention practices that contribute to reductions in infection rates. Sterile tubing change in combination with hub scrub compliance monitoring should be considered in CLABSI reduction efforts.
authors.affiliation: Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia; Department of Pediatrics, Emory University, Atlanta, Georgia; apiazza@emory.edu.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Piazza
authors.affiliation: Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
authors.forename: Beverly
authors.initials: B
authors.lastname: Brozanski
authors.affiliation: Associates in Process Improvement, Austin, Texas.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Provost
authors.affiliation: Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado;
authors.forename: Theresa R
authors.initials: TR
authors.lastname: Grover
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: John
authors.initials: J
authors.lastname: Chuo
authors.affiliation: St Louis Children's Hospital, St Louis, Missouri; Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri;
authors.forename: Joan R
authors.initials: JR
authors.lastname: Smith
authors.affiliation: Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
authors.forename: Teresa
authors.initials: T
authors.lastname: Mingrone
authors.affiliation: Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado;
authors.forename: Susan
authors.initials: S
authors.lastname: Moran
authors.affiliation: Children's Hospital Association; Washington, District of Columbia;
authors.forename: Lorna
authors.initials: L
authors.lastname: Morelli
authors.affiliation: Children's Hospital Association; Washington, District of Columbia;
authors.forename: Isabella
authors.initials: I
authors.lastname: Zaniletti
authors.affiliation: Children's Mercy Kansas City, Kansas City, Missouri; and Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Eugenia K
authors.initials: EK
authors.lastname: Pallotto
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000379:methods; D062905:Central Venous Catheters / Q000009:adverse effects*; D003299:Cooperative Behavior; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007363:Intensive Care Units, Neonatal; D058996:Quality Improvement