Implementing a Sustainable, Phased Approach to Reducing CLABSI Rates in a Level IV NICU.

BACKGROUND

Central line-associated bloodstream infections (CLABSIs) are preventable hospital acquired infections that lead to an increased mortality rate and extended hospital length of stay. Reducing CLABSIs in neonates in a Level IV neonatal intensive care unit (NICU) is challenging due to the complexities of patient diagnoses requiring extended line days and variability in nursing line care.

PURPOSE: The purpose of this quality improvement project is to decrease the rate of CLABSIs from 2 infections per 1000-line days (baseline rate from 2019 to 2022) to less than 1 infection per 1000-line days.

METHODS

A nurse-led interprofessional team benchmarked current line care practices with high-performing Level IV NICUs, reviewed literature and developed recommendations for line care, product trials and improvements in the patient environment to decrease CLABSI risk. Interrupted time series was used to evaluate the interventions.

RESULTS

A phased approach was implemented from September 2022 to April 2023. The CLABSI rate saw a statistically significant decrease from 2.0 to 0.91 infections ( P = .02).

IMPLICATIONS FOR PRACTICE: Reduction of CLABSI rates is a top priority for Level IV NICUs due to the significant short- and long-term impacts for patients. Benchmarking with other NICUs is a valuable practice when neonatal-specific research is unavailable.