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J Pediatr. 2015 Jul;167(1):41-6.e1-3. doi: 10.1016/j.jpeds.2015.03.046. Epub 2015 Apr 25.

Significant Reduction of Central-Line Associated Bloodstream Infections in a Network of Diverse Neonatal Nurseries.

Author information

1
Department of Pediatrics, The Ohio State University, Columbus, OH; Nationwide Children's Hospital, Columbus, OH.
2
Nationwide Children's Hospital, Columbus, OH.
3
Department of Pediatrics, The Ohio State University, Columbus, OH; Nationwide Children's Hospital, Columbus, OH. Electronic address: rick.mcclead@nationwidechildrens.org.

Abstract

OBJECTIVE:

To describe a quality improvement (QI) initiative that was associated with a dramatic reduction in neonatal central-line associated bloodstream infection (CLABSI) rate in a diverse group of 8 intensive care nurseries (Neonatal Services).

STUDY DESIGN:

A quasi-experimental time series QI initiative using the model for improvement and evidenced-based interventions.

RESULTS:

The aggregate CLABSI rate for Nationwide Children's Hospital-associated Neonatal Services decreased from 6.0 CLABSI per 1000 catheter days to 1.43 CLABSI per 1000 catheter days in less than 2 years and has remained in control at 0.68 per 1000 catheter days for over 5 years. Each of 8 nurseries has had a 1 year or more CLABSI-free period, including the neonatal intensive care unit with the largest patient volume, acuity, and central line usage. Aggregate Neonatal Services has experienced 3 CLABSI-free quarters since 2007. Key success factors included: (1) engagement of senior executive leadership; (2) bedside "huddles" among clinical and epidemiology staffs conducted within 72 hours after a positive blood culture; (3) implementation of chlorhexidine antisepsis and the use of chlorhexidine-impregnated catheter site discs; and (4) and establishment of a dedicated team for percutaneously inserted central catheter insertion to serve units in which central lines are placed less frequently.

CONCLUSIONS:

Using the model for improvement and evidenced-based interventions, this QI project has been associated with reduction in the CLABSI rate by 89%, and over 430 CLABSIs likely have been avoided.

PMID:
25917770
DOI:
10.1016/j.jpeds.2015.03.046
[Indexed for MEDLINE]

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