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A quality improvement initiative to reduce central line infection in neonates using checklists

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Abstract

Central line associated blood stream infections (CLABSI) are the most common complication of central catheters in neonates. These infections increase length of hospital stay, hospital costs and impact on mortality and morbidities. We performed a quasi-experimental study, over 24 months, utilising a pre-post design to determine the impact checklists had on central line infections. We introduced checklists for insertion, daily maintenance and procedural access based on the existing clinical guideline. Infections and compliance were monitored and reported back to the unit each month. We utilised the interrupted time series analysis to evaluate the impact of introduction of the checklists. Over the 24 months, 318 infants were included with a total of 509 central lines inserted. In the post intervention phase, definite CLABSI rates declined by 41%, from 13.8 definite CLABSIs per 1000 central-line days to 7.8 definite CLABSIs per 1000 central-line days. There was significant change in the mean levels in the post intervention phase (coefficient crude −0.01015; 95% CI −0.01980–0.00051, p value 0.039). Checklist compliance for insertion was 70%, and daily maintenance compliance overall mean was 66%.

Conclusion: Our quality improvement initiative using checklists, supported with education and feedback, significantly reduced CLABSI in our neonatal unit.

What is Known:

• Central line associated blood stream infection (CLABSI) continue to cause mortality and morbidity in the neonatal population.

• Bundles of intervention use quality improvement methodology to reduce CLABSI and checklists can assist with the introduction of these.

What is New:

• Checklists assist with reducing central line infection.

• To ensure the success of checklists, robust education, leadership and continuous feedback are vital.

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Abbreviations

ANTT:

Aseptic non touch technique

BSI:

Bloodstream infection

ANZNN:

Australian and New Zealand Neonatal Network

CDC:

Centers for Disease Control and Prevention

CLABSI:

Central line associated bloodstream infection

CONS:

Coagulase negative staphylococcus

CVC:

Central venous catheter

ELBW:

Extremely low birth weight

HAI:

Hospital acquired infection

LOS:

Late onset sepsis

NHSN:

National Healthcare Safety Network

PICC:

Peripherally inserted central catheter

UVC:

Umbilical venous catheter

VICNISS:

Victorian Infection Surveillance System

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Authors’ contributions

Ms. Taylor conceptualised and designed the study, designed the data collection tools, checklists, coordinated and supervised data collection, analysed and interpreted the data, drafted the initial manuscript and approved the final manuscript as submitted.

Professor McDonald supervised and assisted in the conceptualisation and design of the study, critically reviewed the manuscript and approved the final submission.

Dr. Earnest analysed and interpreted the data and critically reviewed the manuscript and approved the final submission.

Dr. Tan supervised and assisted in the conceptualisation and design of the study, analysed and interpreted the data and critically reviewed the manuscript and approved the final submission.

Dr. Buttery supervised and assisted in the conceptualisation and design of the study, and critically reviewed the manuscript and approved the final submission.

Ms. Fusinato, Ms. Hovenden and Ms. Wallace collected the data, critically revised the manuscript and approved the final manuscript.

Author information

Authors and Affiliations

  1. LaTrobe University, Bundoora, Victoria, Australia

    Jacqueline E. Taylor

  2. Monash Newborn, Monash Health, Monash medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia

    Jacqueline E. Taylor, Bree Fusinato, Samantha Hovenden, Andrea Wallace & Kenneth Tan

  3. Midwifery Professorial Unit, Mercy Hospital for Women, Heidelberg, Victoria, Australia

    Susan J. McDonald

  4. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    Arul Earnest & Kenneth Tan

  5. Paediatric infectious diseases, Monash Health, Clayton Rd, Clayton, Victoria, Australia

    Jim Buttery

Authors
  1. Jacqueline E. Taylor
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  2. Susan J. McDonald
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  3. Arul Earnest
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  4. Jim Buttery
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  5. Bree Fusinato
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  6. Samantha Hovenden
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  7. Andrea Wallace
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  8. Kenneth Tan
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Corresponding author

Correspondence to Jacqueline E. Taylor.

Ethics declarations

Prior to commencing our quality improvement project, we obtained ethics approval from Monash Health Human Research Ethics Committee and La Trobe University Human Ethics

Funding

No external funding for this manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Additional information

Communicated by Patrick Van Reempts

Revisions received: 21 December 2016; 17 February 2017; 22 February 2017

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Taylor, J.E., McDonald, S.J., Earnest, A. et al. A quality improvement initiative to reduce central line infection in neonates using checklists. Eur J Pediatr 176, 639–646 (2017). https://doi.org/10.1007/s00431-017-2888-x

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  • DOI: https://doi.org/10.1007/s00431-017-2888-x

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