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A Quality Improvement Bundle to Reduce Central Line-Associated Bloodstream Infections in Neonatal Intensive Care
Chiara Poggi1, Giulia Fontanelli1, Martina Ciarcià2
1Division of Neonatology, Department of Mother and Child Care, Careggi University Hospital, 50141 Florence, Italy.
Insights
A new bundle significantly reduced central line-associated bloodstream infections (CLABSIs) in a neonatal intensive care unit (NICU). This intervention lowered both umbilical vein catheter (UVC) and epicutaneo-caval catheter (ECC)-related CLABSIs, improving patient safety.
Area of Science:
- Neonatal Intensive Care Unit (NICU) patient safety
- Infection prevention and control strategies
- Medical device-related infections
Background:
- Central line-associated bloodstream infections (CLABSIs) are a significant concern in neonatal intensive care units (NICUs).
- Dedicated bundles have demonstrated effectiveness in reducing CLABSIs in NICU settings.
Purpose of the Study:
- To evaluate the impact of a CLABSI prevention bundle on catheter-related infections in a NICU.
- To assess the bundle's effect on both umbilical vein catheters (UVCs) and epicutaneo-caval catheters (ECCs).
Main Methods:
- An observational pre-post study design was employed.
- Data included all UVCs and ECCs with a dwell time exceeding 2 days.
- The primary outcome measured was the CLABSI rate per 1000 central line days.
Main Results:
- The CLABSI rate decreased from 10.7 to 3.6 per 1000 central line days after bundle implementation (p=0.042).
- Both UVC-related (7.2/1000 CL days) and ECC-related (12.3/1000 CL days) CLABSIs were significantly reduced.
- Non-infective complications also decreased significantly (20% to 11%, p=0.033).
Conclusions:
- The implemented bundle effectively reduced overall CLABSIs, including those associated with UVCs and ECCs.
- The bundle's efficacy in reducing ECC-related CLABSIs appeared most pronounced within the first 14 days of dwell time.
- Gestational age and bundle implementation were identified as significant predictive factors for CLABSIs.
Abstract:
Background: Dedicated bundles were proven to reduce CLABSIs in a neonatal intensive care unit (NICU). Methods: We performed an observational pre-post study to evaluate the impact of a bundle for CLABSI prevention in our NICU. All umbilical vein catheters (UVCs) and epicutaneo-caval catheters (ECCs) with dwell time > 2 days were included. The primary outcome was CLABSI rate/1000 central line days. Results: A total of 145 catheters (67 UVCs and 78 ECCs) and 142 catheters (65 UVCs and 77 ECCs) were inserted before and after bundle implementation, respectively. The duration of the UVC was significantly shorter before than after the bundle [4 (3-6) vs. 8 (6-11) days; p < 0.0001], while the duration of the ECC did not differ [10 (6-17) vs. 11 (6-19) days; p = 0.711]. CLABSI were less frequent after than before bundle (3.6 vs. 10.7/1000 CL days; p = 0.042); both UVC-related and ECC-related CLABSI were significantly reduced (0 vs. 7.2/1000 CL days, p = 0.015; and 4.4 vs. 12.3/1000 CL days, p = 0.044, respectively). The Kaplan-Meier curve for ECC-related CLABSIs showed no differences between the two periods (p = 0.255), but higher survival without CLABSIs after vs. before bundle was found if considering only ECC with dwell time < 14 days (p = 0.040). Gestational age (p = 0.004) and bundle (p = 0.026) were predictive factors for CLABSIs. Non-infective complications were significantly less frequent after than before bundle (11 vs. 20%, p = 0.033). Conclusions: Our bundle reduced the overall CLABSI rate, and both UVC- and ECC-related CLABSI occurrence. The efficacy for the reduction in ECC-related CLABSIs seems limited to the first 14 days of dwell time.
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