Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists

Joseph Schulman, Rachel Stricof, Timothy P. Stevens, Michael Horgan, Kathleen Gase, Ian R. Holzman, Robert I. Koppel, Suhas Nafday, Kathleen Gibbs, Robert Angert, Aryeh Simmonds, Susan A. Furdon, Lisa Saiman, Lynn Spilman, Susan Boynton, Rebecca O'Donnell, Evelyn DePerna, Randi Wasserman, Yang Kim, Poslyn MayersZina Jones, Larry Colbert, Kavita Kasat, Suzanne Monteleone, Gloria M. Collura, Christine Grippi, Eileen Mulligan, Margaret Lang, Michelle Bode, Dave Martin, Penny Fuller, Angela Shtern, Jaime Fernandez, Margaret Moylan, Alok Bhutada, Shantanu Rastogi, Anna Sullivan, Suhas M. Nafday, Deborah Campbell, Lucille H. Herring, Audrey Adams, Bernard Goldwasser, Ramona Karam-Howlin, Karen D. Hendricks-Munoz, Martha C. Caprio, Joan Cutrone, Michelle DeSomma, Steven Bock, David Bateman, Jennifer Duchon, Diane Carp, Philip Graham, Jeffrey M. Perlman, Mary McCready, Claudette Theuriere, Barbara G. Ross, Deborah Perlmutter, Claire Nagle, Vivian Smith, Richard J. Schanler, Debra Potak, Hyacinth Hoey, Gloria B. Valencia, Nadine E. Lahage, Shanthy Sridhar, Adriann Combs, Michael Cicale, Francina Singh, Patricia Mele, Barbara Clones, Clare Nugent, Heather Brumberg, Venkata Majjiga, Boriana Parvez, Lita Isaacson, Jackie Krumholz, Alice Nash, Ralph Wynn, Linda Eschberger, Kathy Bean, Nancy Elmore, Kathleen A. Gase

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255 Scopus citations


OBJECTIVE: In 2008, all 18 regional referral NICUs in New York state adopted central-line insertion and maintenance bundles and agreed to use checklists to monitor maintenance-bundle adherence and report checklist use. We sought to confirm whether adopting standardized bundles and using central-line maintenance checklists reduced central-line-associated bloodstream infections (CLABSI). METHODS: This was a prospective cohort study that enrolled all neonates with a central line who were hospitalized in any of 18 NICUs. Each NICU reported CLABSI and central-line utilization data and checklist use. We used χ2 to compare CLABSI rates in the preintervention (January to December 2007) versus the postintervention (March to December 2009) periods and Poisson regression to model adjusted CLABSI rates. RESULTS: Each study period included more than 55 000 central-line days and more than 200 000 patient-days. CLABSI rates decreased 67% statewide (risk ratio: 0.33 [95% confidence interval: 0.27-0.41]; P < .0005); after adjusting for the altered central-line- associated bloodstream infection definition in 2008, by 40% (risk ratio: 0.60 [95% confidence interval: 0.48-0.75]; P < .0005). A total of 13 of 18 NICUs reported using maintenance checklists for 10% to 100% of central-line days. The checklist-use rate was associated with the CLABSI rate (coefficient: -0.57, P = .04). A total of 10 of 18 NICUs were independent CLABSI rate predictors, ranging from 1 site with greatly reduced risk (incidence rate ratio: 0.04, P < .0005) to 1 site with greatly increased risk (incidence rate ratio: 2.87, P < .0005). CONCLUSIONS: Although standardizing central-line care elements led to a significant statewide decline in NICU CLABSIs, site of care remains an independent risk factor. Using maintenance checklists reduced CLABSIs.

Original languageEnglish
Pages (from-to)436-444
Number of pages9
Issue number3
StatePublished - Mar 2011


  • Benchmarking
  • Catheter-related infections
  • Health care evaluation
  • Infant
  • Newborn
  • Quality of health care


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