299. Compliance with Bundle Strategies to Reduce Central Line-associated Blood Stream Infections in Neonatal Intensive Care Units in the United States
Session: Poster Abstract Session: HAIs in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • 299_IDWPOSTER.pdf (7.8 MB)
  • Background: Bundle strategies for insertion and maintenance have decreased central line-associated bloodstream infection (CLABSI) rates in the neonatal intensive care unit (NICU). However, there are limited national data on compliance with bundle elements and association with CLABSI rates.

    Methods: NICU-specific CLABSI prevention practices, including compliance with specific bundle components (checklist for bundle, monitoring hand hygiene, checking daily necessity of CLs, using maximal barrier precautions, selecting optimal catheter site) were assessed using a web-based nationwide survey of infection control departments conducted in October 2011. NICU CLABSI rates for 2011 were obtained from the National Healthcare Safety Network (NHSN). The associations between compliance and CLABSI rates were assessed by univariate analyses.

    Results: Of 3,374 eligible hospitals, 1064 hospitals participated in the survey (29%). Of these 189 provided data for Level 2/3 NICUs and gave permission to access their NICU CLABSI rates in NHSN. Most participating NICUs had written policies for at least one bundle component (range per component: 85.0%–94.6%), though fewer had compliance rates >95% (compliance rate >95% per component: 50.8% - 69.3%). The pooled mean CLABSI rate in participating NICUs was 1.1/1000 catheter-days, and by birth weight (BW) <750, 751-1000, 1001-1500, 1501-2500, and >2500 grams was 2.1, 1.5, 1.1, 0.5 and 0.2/1000 catheter-days, respectively. Having a written policy was not associated with overall CLABSI rates (p=0.8). However, >95% compliance with assessment of daily CL necessity was associated with lower overall CLABSI rates (p= 0.03) and lower rates in all BW groups except 751-1000 grams (p<0.05). In addition, >95% compliance with at least one bundle component was associated with lower CLABSI rates in BW groups 1501-2500 and >2500 g (p=0.01, 0.03).  

    Conclusion: Documenting >95% compliance with proven CLABSI prevention strategies was associated with lower CLABSI rates. Assessment of daily CL necessity was associated with lower CLABSI rates overall and in most BW categories. NICUs must continue to emphasize excellent compliance with bundle strategies and judicious use of CLs.

    Philip Zachariah, MD1, E. Yoko Furuya, MD, MS2, Jeffrey Edwards, MD, MA, MAS1, Andrew Dick, PhD3, Hangsheng Liu, PhD, MS, B.Med3, Carolyn Herzig, MS4, Monika Pogorzelska-Maziarz, PhD, MPH4, Patricia Stone, PhD, MPH, RN, FAAN4 and Lisa Saiman, MD, MPH, FSHEA1, (1)Columbia University College of Physicians & Surgeons, New York, NY, (2)Columbia University, New York, NY, (3)RAND Corporation, Boston, MA, (4)Columbia University School of Nursing, New York, NY


    P. Zachariah, None

    E. Y. Furuya, None

    J. Edwards, None

    A. Dick, None

    H. Liu, None

    C. Herzig, None

    M. Pogorzelska-Maziarz, None

    P. Stone, None

    L. Saiman, None

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