A Process Evaluation Approach to Central Line-Associated Bloodstream Infection Reduction in a Neonatal Population

Area of Science:

• Neonatal Intensive Care Unit (NICU) care
• Infection Prevention and Control
• Healthcare Process Improvement

Background:

• Central line-associated bloodstream infections (CLABSI) pose a significant risk in neonatal intensive care units (NICUs).
• Previous infection rates in the M Health Fairview NICU were 2.15 per 1,000 central line days.
• A targeted approach was needed to reduce CLABSI, particularly in vulnerable premature infants.

Purpose of the Study:

• To decrease the incidence of CLABSI in the NICU.
• To achieve a target CLABSI rate of less than one infection per 1,000 central line days.
• To utilize process evaluation for identifying and addressing root causes of central line infections.

Main Methods:

• An interdisciplinary team employed process mapping and Failure Modes and Effects Analysis (FMEA).
• Focus was on neonates born at <32 weeks gestational age and weighing <750 g.
• Interventions included standardizing clean workspaces, developing algorithms to minimize line access, and using standardized kits for line maintenance.

Main Results:

• Achieved an 86.6% reduction in CLABSI events over four years (2019-2023).
• Reduced the CLABSI rate by 85%, from 2.15 to 0.32 per 1,000 line days.
• Demonstrated a significant 33% average reduction in FMEA risk scores for identified failure modes.

Conclusions:

• A process-focused strategy and interdisciplinary teamwork effectively lowered CLABSI rates in the NICU.
• Sustaining these improvements is crucial for future care.
• The ultimate goal is to achieve zero CLABSI events.