Central line catheters are commonly placed in extremely low-birthweight infants to provide venous access for administration of hyperalimentation and medications. Infections is the most common complication of central line catheters in this patient population. With expansion of the neonatal intensive care unit at Allegheny General Hospital and an increase in the number of infants weighing less than 1000 g, there was a proportionate increase in the number of central line catheter days. A multidisciplinary team formed to improve central line care practices to reduce the rate of line infections. The continuous quality improvement process was used to modify central line practices, which led to a decrease in the rate of central line infections. For the first 8 months of 1997, the infection rate was below the 25th percentile according to the National Nosocomial infections Surveillance System data.