A quality improvement initiative to reduce central line infection in neonates using checklists
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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%.
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.
KeywordsCentral venous catheter Infection Infant newborn Quality improvement Checklist
Aseptic non touch technique
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
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.
This article does not contain any studies with human participants performed by any of the authors.