BACKGROUND: The use of central venous catheters has permitted lifesaving treatment for critically ill neonates; however, the attributable mortality rate for central line-associated bloodstream infections (CLABSIs) has been estimated to be between 4% and 20%. In 2006/2007, the authors’ neonatal intensive care unit (NICU) had a CLABSI rate that was nearly twofold higher than that reported by other Canadian NICUs.OBJECTIVE: To implement a quality improvement collaborative to reduce the incidence of neonatal CLABSI.METHODS: A retrospective observational study was performed to compare CLABSI in neonates admitted to the authors’ level III NICU between August 2007 and March 2011. The entire study period was divided into four time periods to evaluate secular trends. A comprehensive catheter-related bloodstream infection prevention initiative was implemented in August 2007. The initiatives included staff education, standardization of skin preparation protocol, introduction of new antiseptic agents, implementation of central catheter insertion and maintenance checklists, reinforcement of the use of maximal sterile barrier precautions, and revision of the central catheter configuration and maintenance protocols.RESULTS: The median CLABSI rate of 7.9 per 1000 catheter days at the beginning of the study (period 1 [August 2007 to June 2008]) gradually decreased over the entire study period (P=0.034): period 2 (July 2008 to May 2009), 3.3 per 1000 catheter days; period 3 (June 2009 to April 2010), 2.6 per 1000 catheter days; and period 4 (May 2010 to March 2011), 2.2 per 1000 catheter days.CONCLUSION: A multidisciplinary evidence-based quality improvement collaborative resulted in a significant reduction in the CLABSI rate. Continuous quality improvement measures are required to reduce catheter-related bloodstream infections among low-birth-weight infants.

中文翻译：

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实施多学科循证质量改进合作后，新生儿重症监护病房中心线相关血流感染率的降低：为期四年的监测。

背景：中心静脉导管的使用使得危重新生儿的救生治疗成为可能。然而，据估计，中心静脉导管相关血流感染 (CLABSIs) 的归因死亡率在 4% 至 20% 之间。在 2006/2007 年，作者的新生儿重症监护病房 (NICU) 的 CLABSI 发生率比其他加拿大 NICU 报告的高近两倍。 目标：实施质量改进协作以降低新生儿 CLABSI 的发生率。方法：进行了一项回顾性观察性研究，以比较 2007 年 8 月至 2011 年 3 月期间入住作者 III 级 NICU 的新生儿的 CLABSI。整个研究期间分为四个时间段以评估长期趋势。2007 年 8 月实施了一项全面的导管相关血流感染预防举措。这些举措包括员工教育、皮肤准备协议的标准化、新防腐剂的引入、中心导管插入和维护清单的实施、加强使用最大无菌屏障预防措施，以及中央导管配置和维护方案的修订。 结果：研究开始时（第 1 期 [2007 年 8 月至 2008 年 6 月]）中位 CLABSI 发生率为每 1000 个导管日 7.9，在整个研究期间逐渐下降（ P=0.034)：第 2 期（2008 年 7 月至 2009 年 5 月），每 1000 个导管日 3.3；第 3 期（2009 年 6 月至 2010 年 4 月），每 1000 个导管日 2.6 个；第 4 期（2010 年 5 月至 2011 年 3 月），每 1000 个导管日 2.2 次。结论：多学科循证质量改进合作导致 CLABSI 率显着降低。需要采取持续的质量改进措施来减少低出生体重婴儿与导管相关的血流感染。