Division of Neonatology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri;
Department of Pediatrics, Emory University - Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia.
Pediatrics. 2017 Oct;140(4). doi: 10.1542/peds.2016-3178.
To evaluate the ability to sustain and further reduce central line-associated bloodstream infection (CLABSI) rates in NICUs participating in a multicenter CLABSI reduction collaborative and to assess the impact of the sterile tubing change (TC) technique as an important component in CLABSI reduction.
A multi-institutional quality improvement collaborative lowered CLABSI rates in level IV NICUs over a 12-month period. During the 19-month sustain phase, centers were encouraged to monitor and report compliance measures but were only required to report the primary outcome measure of the CLABSI rate. Four participating centers adopted the sterile TC technique during the sustain phase as part of a local Plan-Do-Study-Act cycle.
The average aggregate baseline NICU CLABSI rate of 1.076 CLABSIs per 1000 line days was sustained for 19 months across 17 level IV NICUs from January 2013 to July 2014. Four centers transitioning from the clean to the sterile TC technique during the sustain phase had a 64% decrease in CLABSI rates from the baseline (1.59 CLABSIs per 1000 line days to 0.57 CLABSIs per 1000 line days).
Sustaining low CLABSI rates in a multicenter collaborative is feasible with team engagement and ongoing collaboration. With these results, we further demonstrate the positive impact of the sterile TC technique in CLABSI reduction efforts.
评估参与多中心中心静脉相关血流感染（CLABSI）降低合作的新生儿重症监护病房（NICU）维持并进一步降低 CLABSI 率的能力，并评估无菌管更换（TC）技术作为 CLABSI 降低的重要组成部分的影响。
一个多机构质量改进合作在 12 个月的时间内降低了四级 NICU 的 CLABSI 率。在维持阶段的 19 个月中，鼓励中心监测和报告合规措施，但只需要报告 CLABSI 率的主要结果测量值。四个参与中心在维持阶段采用了无菌 TC 技术，作为本地计划-执行-研究-行动周期的一部分。
2013 年 1 月至 2014 年 7 月，17 个四级 NICU 的平均总基线 NICU CLABSI 率为 1.076 例/1000 个导管日，在 19 个月内得到维持。在维持阶段从清洁转为无菌 TC 技术的四个中心的 CLABSI 率从基线下降了 64%（从 1.59 例/1000 个导管日下降至 0.57 例/1000 个导管日）。
通过团队参与和持续合作，在多中心合作中维持低 CLABSI 率是可行的。有了这些结果，我们进一步证明了无菌 TC 技术在 CLABSI 降低工作中的积极影响。
