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

Bizzarro, Matthew J.; Sabo, Barbara; Noonan, Melanie; Bonfiglio, Mary-Pat; Northrup, Veronika; Diefenbach, Karen A.

doi:10.1086/650448

Cited by 131 publications

(107 citation statements)

References 32 publications

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“…3 Conversely, implementation of new knowledge by means of care bundles and infection control practices might stabilize or alter the possible increasing direction. 13,14 The purpose of this study was to identify trends in the incidence densities and pathogen distribution of HABSIs over a long period (20 years, from 1992 through 2011) in a tertiary NICU setting to clearly define baseline data, allowing followup of prevention initiatives. …”

Section: Healthcare-associated Bloodstream Infection (Habsi) Is a Frementioning

confidence: 99%

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Healthcare-Associated Bloodstream Infections in a Neonatal Intensive Care Unit over a 20-Year Period (1992–2011): Trends in Incidence, Pathogens, and Mortality

Verstraete

Boelens

Coen

et al. 2014

Infect. Control Hosp. Epidemiol.

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Objective.To analyze trends in the incidence and pathogen distribution of healthcare-associated bloodstream infections (HABSIs) over a 20-year period (1992–2011).Design.Historical cohort study.Setting.Thirty-two-bed neonatal intensive care unit (NICU) in a tertiary referral hospital.Patients.Neonates with HABSIs defined according to the criteria of the National Institute of Child Health and Development (NICHD).Methods.A hospital-based ongoing surveillance program was used to identify HABSI cases in neonates. A distinction between definite or possible HABSI was made according to the NICHD criteria. Incidence, incidence densities (HABSIs per 1,000 hospital-days and HABSIs per 1,000 total parenteral nutrition–days), and case fatality rate were calculated. Logistic regression analysis was used to find time trends. Four periods of 5 years were considered when executing variance analysis.Results.In total, 682 episodes of HABSIs occurred on 9,934 admissions (6.9%). The median total incidence density rate was 3.1 (interquartile range, 2.2–3.9). A significant increasing time trend in incidence density was observed for the period 1995–2011 (P < .003). A significant decrease in the case fatality rate was found in the last 5-year period (P < .001). No neonate died following possible HABSIs, whereas the case fatality rate among neonates with definite HABSIs was 9.7%. Most HABSIs were caused by coagulase-negative staphylococci (n = 414 [60.7%]). A significant increase in Staphylococcus aureus HABSI was observed in the last 10-year period (P < .001).Conclusions.An increase in incidence density rate occurred, while the case fatality rate dropped. Better perinatal care could be responsible for the latter. A decrease in days before infection and a high incidence of coagulase-negative Staphylococcus HABSIs indicate the need for vigorous application of evidence-based prevention initiatives, in particular for catheter care.

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Section: Healthcare-associated Bloodstream Infection (Habsi) Is a Frementioning

confidence: 99%

“…These numbers might reflect a high amount of contamination and indicate the need for training programs on proper sampling techniques. 14,31 …”

Section: Trends In Pathogen Distributionmentioning

confidence: 99%

Healthcare-Associated Bloodstream Infections in a Neonatal Intensive Care Unit over a 20-Year Period (1992–2011): Trends in Incidence, Pathogens, and Mortality

Verstraete

Boelens

Coen

et al. 2014

Infect. Control Hosp. Epidemiol.

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“…The reduction in infection is, however, in keeping with similar infection prevention bundles in larger studies. 20,21 It is not a randomized trial and therefore is prone to bias. However, the demographic characteristics of infants in the baseline and intervention groups showed no significant differences.…”

Section: Discussionmentioning

confidence: 99%

“…20 These multidisciplinary, evidence-based best practice recommendations are effective in reducing CLABSI in the NICU. 20,21 An audit of CLABSI rates in 2012 at our institution 22 showed 8.5 CLABSI/1,000 central line-days, and 13.4/1,000 central linedays for infants less than 29 weeks' gestation. Comparative data combining rates from all the other level 5 NICUs in New South Wales over the same period using the same definition of CLABSI showed a CLABSI rate of 8.3/1,000 central line-days at less than 29 weeks' gestation.…”

mentioning

confidence: 97%

Impact of a Central Line Infection Prevention Bundle in Newborn Infants

McMullan

Gordon

2016

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo compare central line use and central line–associated bloodstream infection in newborn infants before and after the introduction of a central line infection prevention bundle in order to determine the effectiveness of the bundle and to identify areas for further improvement.DESIGNRetrospective cohort analysis of prospectively collected data.SETTINGLevel 5 neonatal intensive care unit in Sydney, Australia.PATIENTSNewborn infants admitted to the Royal Prince Alfred Hospital Neonatal Intensive Care Unit who had a central venous catheter (CVC) inserted.METHODSData regarding clinical characteristics, CVC use, and infection were collected before and after the introduction of a bundle of interventions. The bundles encompassed (1) insertion of CVC, (2) maintenance of CVC, (3) an education program, and (4) ongoing surveillance and feedback.RESULTSBaseline and intervention groups were comparable in clinical characteristics. The number of CVCs inserted was reduced in the intervention group (central line utilization rate, 0.16 vs 0.2, P<.0001). Overall CVC dwell time was reduced, resulting from significant reduction in peripherally inserted CVC dwell time (6 days [95% CI, 5.0–11.8 days] vs 7.3 days [4.0–10.4 days], P=.0004). Central line–associated bloodstream infections were significantly reduced, predominantly secondary to decreased peripherally inserted CVC–related bloodstream infections (1.2/1,000 central line–days vs 11.5/1,000 central line–days, P<.0001).CONCLUSIONThis central line infection bundle was effective in reducing CVC use, dwell time, and central line–associated bloodstream infections.Infect Control Hosp Epidemiol 2016;37:1029–1036

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“…1,2 CoNS are part of the normal skin flora, and rates of BSI with CoNS have been found to decline after implementation of improved handling of central venous lines. 2,3 In contrast, BSIs with Staphylococcus aureus, gram-negative rods, or fungi have a high mortality risk, 4 with Pseudomonas aeruginosa and Serratia marcescens figuring prominently. 2,3,5,6 Horizontal transmissions of these pathogens in NICUs may cause difficult-to-control outbreaks.…”

mentioning

confidence: 99%

Pathogen-Specific Clustering of Nosocomial Blood Stream Infections in Very Preterm Infants

Reichert¹,

Piening

Geffers

et al. 2016

Pediatrics

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

Cited by 131 publications

References 32 publications

Healthcare-Associated Bloodstream Infections in a Neonatal Intensive Care Unit over a 20-Year Period (1992–2011): Trends in Incidence, Pathogens, and Mortality

Healthcare-Associated Bloodstream Infections in a Neonatal Intensive Care Unit over a 20-Year Period (1992–2011): Trends in Incidence, Pathogens, and Mortality

Impact of a Central Line Infection Prevention Bundle in Newborn Infants

Pathogen-Specific Clustering of Nosocomial Blood Stream Infections in Very Preterm Infants

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