Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-20T05:37:03.357Z Has data issue: false hasContentIssue false
  • English
  • Français

A Quality Improvement Initiative to Reduce Central Line–Associated Bloodstream Infections in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Matthew J. Bizzarro ,
Barbara Sabo ,
Melanie Noonan ,
Mary-Pat Bonfiglio ,
Veronika Northrup ,
Karen Diefenbach  and
Central Venous Catheter Initiative Committee
Matthew J. Bizzarro*
Affiliation:
Departments of Pediatrics, New Haven, Connecticut
Barbara Sabo
Affiliation:
Yale University School of Medicine, the Yale–New Haven Children's Hospital, New Haven, Connecticut
Melanie Noonan
Affiliation:
Yale University School of Medicine, the Yale–New Haven Children's Hospital, New Haven, Connecticut
Mary-Pat Bonfiglio
Affiliation:
Yale University School of Medicine, the Yale–New Haven Children's Hospital, New Haven, Connecticut
Veronika Northrup
Affiliation:
Biostatistics Support Unit, Yale Center for Clinical Investigation, New Haven, Connecticut
Karen Diefenbach
Affiliation:
Surgery, New Haven, Connecticut
*
Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520-8064 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Extract

Objective.

To reduce the rate of late-onset sepsis in a neonatal intensive care unit (NICU) by decreasing the rate of central line–associated bloodstream infection (CLABSI).

Methods.

We conducted a quasi-experimental study of an educational intervention designed to improve the quality of clinical practice in an NICU. Participants included all NICU patients with a central venous catheter (CVC). Data were collected during the period from July 1, 2005, to June 30, 2007, to document existing CLABSI rates and CVC-related practices. A multidisciplinary quality improvement committee was established to review these and published data and to create guidelines for CVC placement and management. Educational efforts were conducted to implement these practices. Postintervention CLABSI rates were collected during the period from January 1, 2008, through March 31, 2009, and compared with preintervention data and with benchmark data from the National Healthcare Safety Network (NHSN).

Results.

The rate of CLABSI in the NICU decreased from 8.40 to 1.28 cases per 1,000 central line–days (adjusted rate ratio, 0.19 [95% confidence interval, 0.08–0.45]). This rate was lower than the NHSN benchmark rate for level III NICUs. The overall rate of late-onset sepsis was reduced from 5.84 to 1.42 cases per 1,000 patient-days (rate difference, −4.42 cases per 1,000 patient-days [95% confidence interval, −5.55 to −3.30 cases per 1,000 patient-days]).

Conclusions.

It is possible to reduce the rate of CLABSI, and therefore the rate of late-onset sepsis, by establishing and adhering to evidence-based guidelines. Sustainability depends on continued data surveillance, knowledge of medical and nursing literature, and timely feedback to the staff. The techniques established are applicable to other populations and areas of inpatient care.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 3 , March 2010 , pp. 241 - 248
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Stoll, BJ, Gordon, T, Korones, SB, et al.Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996;129(1):63–71.Google Scholar
2.Stoll, BJ, Hansen, N, Fanaroff, AA, et al.Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110(2):285–291.CrossRefGoogle ScholarPubMed
3.Jiang, JH, Chiu, NC, Huang, FY, et al.Neonatal sepsis in the neonatal intensive care unit: characteristics of early versus late onset. J Microbiol Immunol Infect 2004;37(5):301–306.Google ScholarPubMed
4.Bizzarro, MJ, Raskind, C, Baltimore, RS, Gallagher, PG. Seventy-five years of neonatal sepsis at Yale: 1928–2003. Pediatrics 2005;116(3):595–602.CrossRefGoogle ScholarPubMed
5.Stoll, BJ, Hansen, N. Infections in VLBW infants: studies from the NICHD neonatal research network. Semin Perinatol 2003;27(4):293–301.CrossRefGoogle ScholarPubMed
6.Payne, NR, Carpenter, JH, Badger, GJ, Horbar, JD, Rogowski, J. Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants. Pediatrics 2004;114(2):348–355.Google Scholar
7.Stark, AR; American Academy of Pediatrics Committee on Fetus and Newborn. Levels of neonatal care. Pediatrics 2004;114(5):1341–1347.Google Scholar
8.Edwards, JR, Peterson, KD, Andrus, ML, et al; NHSN Facilities. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2007;35(5):290–301.CrossRefGoogle ScholarPubMed
9.Horan, TC, Gaynes, RP. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control, 3rd ed. Philadelphia PA: Lippincott, Williams, and Wilkins; 2004:1659–1702.Google Scholar
10.Aly, H, Herson, V, Duncan, A, et al.Is bloodstream infection preventable among premature infants? A tale of two cities. Pediatrics 2005;115:1513–1518.Google Scholar
11.Department of Health. Standard principles for preventing hospital-acquired infections. J Hosp Infect 2001;47(suppl 1):S21–S37.CrossRefGoogle Scholar
12.Department of Health. Guidelines for preventing infections associated with the insertion and maintenance of central venous catheters. J Hosp Infect 2001;47(suppl 1):S47–S67.Google Scholar
13.Eggimann, P, Harbarth, S, Constantin, MN, Touveneau, S, Chevrolet, JC, Pittet, D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet 2000;355:1864–1868.CrossRefGoogle ScholarPubMed
14.Eggimann, P, Hugonnet, S, Sax, H, Harbarth, S, Chevrolet, JC, Pittet, D. Long-term reduction of vascular access-associated bloodstream infection. Ann Intern Med 2005;142:875–876.CrossRefGoogle ScholarPubMed
15.Kennedy, AM, Elward, AM, Fraser, VJ. Survey of knowledge, beliefs, and practices of neonatal intensive care unit healthcare workers regarding nosocomial infections, central venous catheter care, and hand hygiene. Infect Control Hosp Epidemiol 2004;25:747–752.CrossRefGoogle ScholarPubMed
16.Kilbride, HW, Powers, R, Wirtschafter, DD, et al.Evaluation and development of potentially better practices to prevent neonatal nosocomial bacteremia. Pediatrics 2003;111:e504–e518.Google Scholar
17.Kilbride, HW, Wirtschafter, DD, Powers, RJ, Sheehan, MB. Implementation of evidence-based potentially better practices to decrease nosocomial infections. Pediatrics 2003;111:e519–e533.CrossRefGoogle ScholarPubMed
18.Maas, A, Flament, P, Pardou, A, Deplano, A, Dramaix, M, Struelens, MJ. Central venous catheter-related bacteraemia in critically ill neonates: risk factors and impact of a prevention programme. J Hosp Infect 1998;40:211–224.CrossRefGoogle ScholarPubMed
19.O'Grady, NP, Alexander, M, Dellinger, EP, et al; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter–related infections. Infect Control Hosp Epidemiol 2002;23:759–769.Google Scholar
20.Pronovost, P, Needham, D, Berenholtz, S, et al.An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.CrossRefGoogle ScholarPubMed
21.Sherertz, RJ, Ely, EW, Westbrook, DM, et al.Education of physicians-intraining can decrease the risk for vascular catheter infection. Ann Intern Med 2000;132:641–648.Google Scholar
22.Maki, DG, Stolz, SS, Wheeler, S, Mermel, LA. A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management. Crit Care Med 1994;22(11):1729–1737.Google Scholar
23.Zenk, K, Gerbasi, J, Summed, E, Sills, J, Mackie, G, Thrupp, L. Central venous catheterization in neonates: pilot evaluation of long-term transparent dressings. Neonatal Pharmacol Q 1999;2:25–30.Google Scholar
24.Evans, M, Lentsch, D. Percutaneously inserted polyurethane central catheters in the NICU: one unit's experience. Neonatal Netw 1999;18(6):37–46.CrossRefGoogle ScholarPubMed
25.Boo, NY, Wong, NC, Zulkifli, SS, Lye, MS. Risk factors associated with umbilical vascular catheter-associated thrombosis in newborn infants. J Paediatr Child Health 1999;35(5):460–465.Google Scholar
26.Butler-O'Hara, M, Buzzard, CJ, Reubens, L, McDermott, MP, DiGrazio, W, D'Angio, CT. A randomized trial comparing long-term and short-term use of umbilical venous catheters in premature infants with birth weights of less than 1251 grams. Pediatrics 2006;118(1):e25–e35.CrossRefGoogle ScholarPubMed
27.Loisel, DB, Smith, MM, MacDonald, MG, Martin, GR. Intravenous access in newborn infants: impact of extended umbilical venous catheter use on requirement for peripheral venous lines. J Perinatol 1996;16(6):461–466.Google Scholar
28.Fletcher, MA, Brown, DR, Landers, S, Seguin, J. Umbilical arterial catheter use: report of an audit conducted by the Study Group for Complications of Perinatal Care. Am J Perinatol 1994;11(2):94–99.Google Scholar
29.Seguin, J, Fletcher, MA, Landers, S, Brown, D, Macpherson, T. Umbilical venous catheterizations: audit by the Study Group for Complications of Perinatal Care. Am J Perinatol 1994;11(1):67–70.CrossRefGoogle Scholar
30.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infection in the acute care setting. Am J Infect Control 2008;36(5):309–332.CrossRefGoogle ScholarPubMed
31.Edwards, JR, Peterson, KD, Andrus, ML, Dudeck, MA, Pollock, DA, Horan, TC; National Healthcare Safety Network Facilities. National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control 2008;36(9):609–626.CrossRefGoogle ScholarPubMed
32.Holford, TR. Multivariate Methods in Epidemiology. Oxford: Oxford University Press; 2002:81–104.CrossRefGoogle Scholar
33.Kirkwood, BR, Sterne, JAC. Essential Medical Statistics, 2nd ed. Massachusetts: Blackwell Science; 2001:240–248.Google Scholar
34.Kaufman, D, Fairchild, KD. Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants. Clin Microbiol Rev 2004;17(3):638–680.CrossRefGoogle ScholarPubMed
35.Stoll, BJ, Hansen, NI, Adams-Chapman, I, et al; National Institute of Child Health and Human Development Neonatal Research Network. Neuro-developmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004;292(19):2357–2365.CrossRefGoogle Scholar
36.Centers for Disease Control and Prevention (CDC). Early-onset group B streptococcal disease—United States, 1998–1999. MMWR Morb Mortal Wkly Rep 2000;49:793–796.Google Scholar
37.Centers for Disease Control and Prevention (CDC). Perinatal group B streptococcal disease after universal screening recommendations—United States, 2003–2005. MMWR Morb Mortal Wkly Rep 2007;56(28):701–705.Google Scholar
38.Fanaroff, AA, Hack, M, Walsh, MC. The NICHD neonatal research network: changes in practice and outcomes during the first 15 years. Semin Perinatol 2003;27(4):281–287.CrossRefGoogle Scholar
39.Gaynes, RP, Edwards, JR, Jarvis, WR, Culver, DH, Tolson, JS, Martone, WJ. Nosocomial infections among neonates in high-risk nurseries in the United States: National Nosocomial Infections Surveillance System. Pediatrics 1996;98:357–361.Google Scholar