655 - A Quality Improvement Initiative to Reduce the Rate of Central Line-Associated Bloodstream Infections in a Level IV NICU

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 655
Publication Number: 655.138

Liana Senaldi, Weill Cornell Medicine, New York, NY, United States; Vivien Yap, Weill Cornell Medicine, New York, NY, United States; Jean-Marie Cannon, New York Presbyterian-Weill Cornell Medical Center, New York, NY, United States; Karen P. Acker, Weill Cornell Medicine, New York, NY, United States; Lauren McMahon, Weill Cornell Medicine, New York, NY, United States; Christel Vasquez, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Caitlin Ehret, NewYork-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Snezana Nena Osorio, Weill Cornell Medical College, New York, NY, United States; Priyanka Tiwari, Weill Cornell Medicine, New Hyde Park, NY, United States

Presenting Author(s)

Liana Senaldi, MD (she/her/hers)

Neonatologist
Weill Cornell Medicine
New York, New York, United States

Background: Neonatal intensive care unit (NICU) patients are one of the most vulnerable populations for central line-associated bloodstream infections (CLABSIs) due to extended hospitalizations and necessary central line access. CLABSIs are associated with significant morbidity and mortality. We identified risk factors for infants at high-risk for CLABSIs (including femoral line, presence of additional devices, dwell time ≥ 2 weeks, history of thrombus, and history of CLABSI), and created a high-risk maintenance bundle to implement in our level IV NICU.

Objective: The primary aim was to increase the time interval between CLABSI events by 50%, from a center line (CL) of 36 days, by July 2023. The secondary aim was to decrease NICU central line days/1000 patient days present by 10% by July 2023.

Design/Methods: This ongoing QI study utilized the Model for Improvement with a series of sequential interventions. Baseline data were collected from January 2021 to December 2021. Interventions included implementation of central line maintenance guidelines, education of NICU staff, creation of a high-risk bundle protocol, and weekly multidisciplinary device rounds to review adherence to central line maintenance guidelines. Outcome and process measures included the time interval between CLABSI events, central line days/1000 patient days present, and compliance of central line audits. Balance measures included incidence of other hospital acquired conditions (HACs), including unplanned extubations and pressure injuries, as well as burns from chlorhexidine gluconate baths. Statistical process control charts (T-chart, U-chart, and P-chart) were used to display and analyze data. Associates for Process Improvement rules for special cause were applied.

Results:

There was no special cause variation in the number of days between CLABSI events (CL = 36), however the time interval since the last CLABSI event has been 203 days to present day (Fig 1). There was an 18% reduction in central line days/1000 patient days present (Fig 2). Since initiation of multidisciplinary device rounds, there was an increase from 95% to 99% compliant central line audits (Fig 3). There were no cases of other HACs, and no burns from initiation of chlorhexidine gluconate baths for those patients who met criteria.

Conclusion(s): Adoption of standardized practices, including bundles and checklists, combined with targeted multidisciplinary device rounds may lead to a significant reduction in CLABSIs. Future interventions include creation of central line insertion guidelines and an electronic medical record hard stop for central line necessity.