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Is zero central line-associated bloodstream infection rate sustainable? A 5-year perspective
Carmina Erdei1, Linda L McAvoy2, Munish Gupta3
1Division of Neonatology, Department of Pediatrics (Neonatology), Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; carmina.erdei@gmail.com.
Insights
Implementing evidence-based catheter care significantly reduced central line-associated bloodstream infections (CLABSI) in the NICU. Sustaining these reductions required ongoing training, vigilance, and documentation for long-term success.
Area of Science:
- Neonatal Intensive Care Unit (NICU) care practices
- Infection control and prevention strategies
- Healthcare quality improvement initiatives
Background:
- Central line-associated bloodstream infections (CLABSI) pose a significant risk in Neonatal Intensive Care Units (NICUs).
- Implementing evidence-based practices is crucial for reducing CLABSI rates.
- Sustainability of these reductions is essential for long-term patient safety.
Purpose of the Study:
- To evaluate the sustainability of CLABSI rate reduction for at least one year.
- To identify key determinants contributing to the sustainability of these reductions in a NICU setting.
- To assess the long-term impact of standardized care practices on CLABSI incidence.
Main Methods:
- A retrospective review of CLABSI incidence was conducted over a 5-year period (July 2008 to December 2013).
- CLABSI rates were analyzed temporally in relation to the implementation of new practice policies and procedures.
- Key drivers for sustained reduction were identified through ongoing surveillance and analysis.
Main Results:
- Standardized care practices, including bundles and checklists, reduced CLABSI rates significantly, achieving zero infections for over 370 consecutive days in 2012.
- Overall CLABSI rates decreased by 77% from 4.1 per 1000 line days in 2009 to 0.94 in 2013.
- Interventions successfully maintained zero CLABSI rates for over 600 days after a brief increase in 2013, highlighting the effectiveness of ongoing vigilance.
Conclusions:
- High-quality training, strict adherence to evidence-based guidelines, and meticulous documentation are vital for significant CLABSI reductions.
- Sustained exceptional performance requires mindful organizational strategies to manage demands and maintain vigilance.
- Continuous quality improvement and robust surveillance are key to long-term success in preventing healthcare-associated infections.
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.
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