title: A quality improvement initiative to reduce central line infection in neonates using checklists.
abstract: Central line associated blood stream infections (CLABSI) are the most common complication of central catheters in neonates. These infections increase length of hospital stay, hospital costs and impact on mortality and morbidities. We performed a quasi-experimental study, over 24 months, utilising a pre-post design to determine the impact checklists had on central line infections. We introduced checklists for insertion, daily maintenance and procedural access based on the existing clinical guideline. Infections and compliance were monitored and reported back to the unit each month. We utilised the interrupted time series analysis to evaluate the impact of introduction of the checklists. Over the 24 months, 318 infants were included with a total of 509 central lines inserted. In the post intervention phase, definite CLABSI rates declined by 41%, from 13.8 definite CLABSIs per 1000 central-line days to 7.8 definite CLABSIs per 1000 central-line days. There was significant change in the mean levels in the post intervention phase (coefficient crude -0.01015; 95% CI -0.01980-0.00051, p value 0.039). Checklist compliance for insertion was 70%, and daily maintenance compliance overall mean was 66%.
  
  
  CONCLUSIONS
  Our quality improvement initiative using checklists, supported with education and feedback, significantly reduced CLABSI in our neonatal unit. What is Known: • Central line associated blood stream infection (CLABSI) continue to cause mortality and morbidity in the neonatal population. • Bundles of intervention use quality improvement methodology to reduce CLABSI and checklists can assist with the introduction of these. What is New: • Checklists assist with reducing central line infection. • To ensure the success of checklists, robust education, leadership and continuous feedback are vital.
authors.affiliation: LaTrobe University, Bundoora, Victoria, Australia. Jacquie.taylor@monashhealth.org.|Monash Newborn, Monash Health, Monash medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia. Jacquie.taylor@monashhealth.org.
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Taylor
authors.affiliation: Midwifery Professorial Unit, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: McDonald
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Arul
authors.initials: A
authors.lastname: Earnest
authors.affiliation: Paediatric infectious diseases, Monash Health, Clayton Rd, Clayton, Victoria, Australia.
authors.forename: Jim
authors.initials: J
authors.lastname: Buttery
authors.affiliation: Monash Newborn, Monash Health, Monash medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
authors.forename: Bree
authors.initials: B
authors.lastname: Fusinato
authors.affiliation: Monash Newborn, Monash Health, Monash medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Hovenden
authors.affiliation: Monash Newborn, Monash Health, Monash medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wallace
authors.affiliation: Monash Newborn, Monash Health, Monash medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tan
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D057189:Checklist / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D065228:Non-Randomized Controlled Trials as Topic; D058996:Quality Improvement; D018709:Statistics, Nonparametric
keywords: Central venous catheter; Checklist; Infant newborn; Infection; Quality improvement