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Pediatrics. 2015 Jun;135(6):e1485-93. doi: 10.1542/peds.2014-2523. Epub 2015 May 18.

Is zero central line-associated bloodstream infection rate sustainable? A 5-year perspective.

Author information

1
Division of Neonatology, Department of Pediatrics (Neonatology), Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; carmina.erdei@gmail.com.
2
Division of Neonatology, Department of Pediatrics (Neonatology), Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts;
3
Department of Pediatrics (Neonatology), Beth Israel Deaconess Medical Center, Boston, Massachusetts; and.
4
Department of Pediatrics (Neonatology), Women and Infants' Hospital, Providence, Rhode Island.

Abstract

BACKGROUND AND OBJECTIVE:

Adoption and implementation of evidence-based measures for catheter care leads to reductions in central line-associated bloodstream infection (CLABSI) rates in the NICU. The purpose of this study is to evaluate whether this rate reduction is sustainable for at least 1 year and to identify key determinants of this sustainability at the NICU of the Floating Hospital for Children at Tufts Medical Center.

METHODS:

We reviewed the incidence of CLABSIs in the NICU temporally to the implementation of new practice policies and procedures, from July 2008 to December 2013.

RESULTS:

Adoption of standardized care practices, including bundles and checklists, was associated with a significant reduction of the CLABSI rate to zero for >370 consecutive days in our NICU in 2012. Overall, our CLABSI rates decreased from 4.1 per 1000 line days in 2009 (13 infections; 3163 line days) to 0.94 in 2013 (2 infections; 2115 line days), which represents a 77% reduction over a 5-year period. In the first quarter of 2013, there was a brief increase in CLABSI rate to 3.3 per 1000 line days; after a series of interventions, the CLABSI rate was maintained at zero for >600 days. Ongoing training, surveillance, and vigilance with catheter insertion and maintenance practices and improved documentation were identified as key drivers for success.

CONCLUSIONS:

High-quality training, strict compliance with evidence-based guidelines, and thorough documentation is associated with significant reductions in CLABSIs. Mindful organizing may lead to a better understanding of what goes into a unit's ability to handle peak demands and sustain extraordinary performance in the long-term.

PMID:
25986020
DOI:
10.1542/peds.2014-2523
[Indexed for MEDLINE]
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