European Journal of Pediatrics

, Volume 176, Issue 5, pp 639–646 | Cite as

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

  • Jacqueline E. Taylor
  • Susan J. McDonald
  • Arul Earnest
  • Jim Buttery
  • Bree Fusinato
  • Samantha Hovenden
  • Andrea Wallace
  • Kenneth Tan
Original Article


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.


Central venous catheter Infection Infant newborn Quality improvement Checklist 



Aseptic non touch technique


Bloodstream infection


Australian and New Zealand Neonatal Network


Centers for Disease Control and Prevention


Central line associated bloodstream infection


Coagulase negative staphylococcus


Central venous catheter


Extremely low birth weight


Hospital acquired infection


Late onset sepsis


National Healthcare Safety Network


Peripherally inserted central catheter


Umbilical venous catheter


Victorian Infection Surveillance System


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.

Compliance with ethical standards

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


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.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Jacqueline E. Taylor
    • 1
    • 2
  • Susan J. McDonald
    • 3
  • Arul Earnest
    • 4
  • Jim Buttery
    • 5
  • Bree Fusinato
    • 2
  • Samantha Hovenden
    • 2
  • Andrea Wallace
    • 2
  • Kenneth Tan
    • 2
    • 4
  1. 1.LaTrobe UniversityBundooraAustralia
  2. 2.Monash NewbornMonash Health, Monash medical CentreClaytonAustralia
  3. 3.Midwifery Professorial UnitMercy Hospital for WomenHeidelbergAustralia
  4. 4.Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
  5. 5.Paediatric infectious diseasesMonash HealthClaytonAustralia

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