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

  • Matthew J. Bizzarro (a1), Barbara Sabo (a2), Melanie Noonan (a2), Mary-Pat Bonfiglio (a2), Veronika Northrup (a3) and Karen Diefenbach (a4)...

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).


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).


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]).


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.

Corresponding author
Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520-8064 (
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1. BJ Stoll , T Gordon , SB Korones , 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):6371.

2. BJ Stoll , N Hansen , AA Fanaroff , et al.Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110(2):285291.

4. MJ Bizzarro , C Raskind , RS Baltimore , PG Gallagher . Seventy-five years of neonatal sepsis at Yale: 1928–2003. Pediatrics 2005;116(3):595602.

5. BJ Stoll , N Hansen . Infections in VLBW infants: studies from the NICHD neonatal research network. Semin Perinatol 2003;27(4):293301.

6. NR Payne , JH Carpenter , GJ Badger , JD Horbar , J Rogowski . 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):348355.

8. JR Edwards , KD Peterson , ML Andrus , et al; NHSN Facilities. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2007;35(5):290301.

10. H Aly , V Herson , A Duncan , et al.Is bloodstream infection preventable among premature infants? A tale of two cities. Pediatrics 2005;115:15131518.

11.Department of Health. Standard principles for preventing hospital-acquired infections. J Hosp Infect 2001;47(suppl 1):S21S37.

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):S47S67.

13. P Eggimann , S Harbarth , MN Constantin , S Touveneau , JC Chevrolet , D Pittet . Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet 2000;355:18641868.

14. P Eggimann , S Hugonnet , H Sax , S Harbarth , JC Chevrolet , D Pittet . Long-term reduction of vascular access-associated bloodstream infection. Ann Intern Med 2005;142:875876.

15. AM Kennedy , AM Elward , VJ Fraser . 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;25:747752.

18. A Maas , P Flament , A Pardou , A Deplano , M Dramaix , MJ Struelens . Central venous catheter-related bacteraemia in critically ill neonates: risk factors and impact of a prevention programme. J Hosp Infect 1998;40:211224.

19. NP O'Grady , M Alexander , EP Dellinger , et al; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter–related infections. Infect Control Hosp Epidemiol 2002;23:759769.

20. P Pronovost , D Needham , S Berenholtz , et al.An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:27252732.

21. RJ Sherertz , EW Ely , DM Westbrook , et al.Education of physicians-intraining can decrease the risk for vascular catheter infection. Ann Intern Med 2000;132:641648.

22. DG Maki , SS Stolz , S Wheeler , LA Mermel . 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):17291737.

24. M Evans , D Lentsch . Percutaneously inserted polyurethane central catheters in the NICU: one unit's experience. Neonatal Netw 1999;18(6):3746.

25. NY Boo , NC Wong , SS Zulkifli , MS Lye . Risk factors associated with umbilical vascular catheter-associated thrombosis in newborn infants. J Paediatr Child Health 1999;35(5):460465.

26. M Butler-O'Hara , CJ Buzzard , L Reubens , MP McDermott , W DiGrazio , CT D'Angio . 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):e25e35.

28. MA Fletcher , DR Brown , S Landers , J Seguin . Umbilical arterial catheter use: report of an audit conducted by the Study Group for Complications of Perinatal Care. Am J Perinatol 1994;11(2):9499.

29. J Seguin , MA Fletcher , S Landers , D Brown , T Macpherson . Umbilical venous catheterizations: audit by the Study Group for Complications of Perinatal Care. Am J Perinatol 1994;11(1):6770.

30. TC Horan , M Andrus , MA Dudeck . 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):309332.

31. JR Edwards , KD Peterson , ML Andrus , MA Dudeck , DA Pollock , TC Horan ; 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):609626.

32. TR Holford . Multivariate Methods in Epidemiology. Oxford: Oxford University Press; 2002:81104.

34. D Kaufman , KD Fairchild . Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants. Clin Microbiol Rev 2004;17(3):638680.

35. BJ Stoll , NI Hansen , I Adams-Chapman , 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):23572365.

38. AA Fanaroff , M Hack , MC Walsh . The NICHD neonatal research network: changes in practice and outcomes during the first 15 years. Semin Perinatol 2003;27(4):281287.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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