Quality Improvement to Reduce Neonatal CLABSI: The Journey to Zero

Abstract

Neonatal infections, including those associated with central lines, continue to be a major cause of morbidity and mortality despite many other improvements in neonatal outcomes. Over the past decades, significant advances have been made to reduce central line-associated bloodstream infections (CLABSIs) using quality improvement methodology. This article will review pertinent studies that used both the Institute for Healthcare Improvement Model for Improvement and other innovative techniques such as orchestrated testing and health care failure mode and effects analysis. These studies, by applying best practices, have demonstrated substantial and sustainable reductions in CLABSI. Some initiatives have been able to achieve rates of zero CLABSI for prolonged periods of time. While neonates often require prolonged central venous access and suffer from impaired immunity which increases the risk of CLABSI, this review demonstrates the journey to zero is feasible. Key Points

Does the antimicrobial-impregnated peripherally inserted central catheter decrease the CLABSI rate in neonates? Results from a retrospective cohort study

“…A systematic review and network meta-analysis of the adult population demonstrated that antimicrobial-impregnated CVCs significantly reduced the CLABSI rate compared with standard catheters (15). The early insertion, use of glue, MST insertion technique, single lumen catheters, a small number of attempts, and the use of lipid emulsion to facilitate the guidewire removal are all significantly higher in the miconazole and rifampicinimpregnated catheter and are all supposed to reduce the CLABSI rate (25,35,36). On the other hand, the birth weight and the gestational age were significantly lower in the miconazole and rifampicin-impregnated catheter group together with the longer dwell time compared with the conventional PICC.…”

Infecção primária da corrente sanguínea associada ao cateter venoso central em neonatos/ Central venous catheter-associated primary bloodstream infection in neonates

“…2022;21:e59515 mãos e preparação da pele (14,17) . É fato que a higienização das mãos é a medida mais simples e de menor custo para a prevenção das infecções relacionadas a assistência à saúde, visto a complexidade da assistência à saúde do neonato, sendo imprescindível o incentivo, adesão a essa medida e a implementação dos bundles como primordial (18,19) .…”

“…Entretanto, deve ser ter cautela na utilização de clorexidina, principalmente a solução alcoólica, devido ao risco de lesão de pele, especialmente, em prematuros extremos (21) . A existência de uma variedade de estratégias tanto na inserção e como na manutenção do CVC evidencia a necessidade de conhecimento e avaliação antecipada do local ou unidade de implantação, para elaborar estratégia personalizada de acordo com as características e necessidade da instituição (19,21) . A segurança do paciente em UTIN neonatal, que inclui a prevenção e controle de IRAS, requer várias medidas primordiais, dentre elas, a necessidade de mudanças culturais em relação à segurança do paciente e à formação dos profissionais, à inserção da família no cuidado e à assistência humanizada (22) .…”

Neonatal bloodstream infections

“…Given the associated morbidity and financial burden of CLABSI, quality improvement processes and research endeavors must persist to minimize CLABSI across the nation. Through measures such as a vascular access team, multidisciplinary involvement, and bundles, we can continue to reduce the incidence and impact of neonatal CLABSIs with the ultimate goal of getting to zero [14].…”