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 E. 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

Research output: Contribution to journalArticle

203 Citations (Scopus)

Abstract

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 (US)
Pages (from-to)436-444
Number of pages9
JournalPediatrics
Volume127
Issue number3
DOIs
StatePublished - Mar 2011

Fingerprint

Checklist
Infection
Maintenance
Odds Ratio
Confidence Intervals
Incidence
Cohort Studies
Referral and Consultation
Newborn Infant
Prospective Studies

Keywords

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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Schulman, J., Stricof, R., Stevens, T. P., Horgan, M., Gase, K., Holzman, I. R., ... Gase, K. A. (2011). Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics, 127(3), 436-444. https://doi.org/10.1542/peds.2010-2873

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

In: Pediatrics, Vol. 127, No. 3, 03.2011, p. 436-444.

Research output: Contribution to journalArticle

Schulman, J, Stricof, R, Stevens, TP, Horgan, M, Gase, K, Holzman, IR, Koppel, RI, Nafday, S, Gibbs, K, Angert, R, Simmonds, A, Furdon, SA, Saiman, L, Spilman, L, Boynton, S, O'Donnell, R, DePerna, E, Wasserman, R, Kim, Y, Mayers, P, Jones, Z, Colbert, L, Kasat, K, Monteleone, S, Collura, GM, Grippi, C, Mulligan, E, Lang, M, Bode, M, Martin, D, Fuller, P, Shtern, A, Fernandez, J, Moylan, M, Bhutada, A, Rastogi, S, Sullivan, A, Nafday, SM, Campbell, DE, Herring, LH, Adams, A, Goldwasser, B, Karam-Howlin, R, Hendricks-Munoz, KD, Caprio, MC, Cutrone, J, DeSomma, M, Bock, S, Bateman, D, Duchon, J, Carp, D, Graham, P, Perlman, JM, McCready, M, Theuriere, C, Ross, BG, Perlmutter, D, Nagle, C, Smith, V, Schanler, RJ, Potak, D, Hoey, H, Valencia, GB, Lahage, NE, Sridhar, S, Combs, A, Cicale, M, Singh, F, Mele, P, Clones, B, Nugent, C, Brumberg, H, Majjiga, V, Parvez, B, Isaacson, L, Krumholz, J, Nash, A, Wynn, R, Eschberger, L, Bean, K, Elmore, N & Gase, KA 2011, 'Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists', Pediatrics, vol. 127, no. 3, pp. 436-444. https://doi.org/10.1542/peds.2010-2873
Schulman, Joseph ; Stricof, Rachel ; Stevens, Timothy P. ; Horgan, Michael ; Gase, Kathleen ; Holzman, Ian R. ; Koppel, Robert I. ; Nafday, Suhas ; Gibbs, Kathleen ; Angert, Robert ; Simmonds, Aryeh ; Furdon, Susan A. ; Saiman, Lisa ; Spilman, Lynn ; Boynton, Susan ; O'Donnell, Rebecca ; DePerna, Evelyn ; Wasserman, Randi ; Kim, Yang ; Mayers, Poslyn ; Jones, Zina ; Colbert, Larry ; Kasat, Kavita ; Monteleone, Suzanne ; Collura, Gloria M. ; Grippi, Christine ; Mulligan, Eileen ; Lang, Margaret ; Bode, Michelle ; Martin, Dave ; Fuller, Penny ; Shtern, Angela ; Fernandez, Jaime ; Moylan, Margaret ; Bhutada, Alok ; Rastogi, Shantanu ; Sullivan, Anna ; Nafday, Suhas M. ; Campbell, Deborah E. ; Herring, Lucille H. ; Adams, Audrey ; Goldwasser, Bernard ; Karam-Howlin, Ramona ; Hendricks-Munoz, Karen D. ; Caprio, Martha C. ; Cutrone, Joan ; DeSomma, Michelle ; Bock, Steven ; Bateman, David ; Duchon, Jennifer ; Carp, Diane ; Graham, Philip ; Perlman, Jeffrey M. ; McCready, Mary ; Theuriere, Claudette ; Ross, Barbara G. ; Perlmutter, Deborah ; Nagle, Claire ; Smith, Vivian ; Schanler, Richard J. ; Potak, Debra ; Hoey, Hyacinth ; Valencia, Gloria B. ; Lahage, Nadine E. ; Sridhar, Shanthy ; Combs, Adriann ; Cicale, Michael ; Singh, Francina ; Mele, Patricia ; Clones, Barbara ; Nugent, Clare ; Brumberg, Heather ; Majjiga, Venkata ; Parvez, Boriana ; Isaacson, Lita ; Krumholz, Jackie ; Nash, Alice ; Wynn, Ralph ; Eschberger, Linda ; Bean, Kathy ; Elmore, Nancy ; Gase, Kathleen A. / Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. In: Pediatrics. 2011 ; Vol. 127, No. 3. pp. 436-444.
@article{1f6bdb70496a4de2a6b094b204e588fd,
title = "Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists",
abstract = "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.",
keywords = "Benchmarking, Catheter-related infections, Health care evaluation, Infant, Newborn, Quality of health care",
author = "Joseph Schulman and Rachel Stricof and Stevens, {Timothy P.} and Michael Horgan and Kathleen Gase and Holzman, {Ian R.} and Koppel, {Robert I.} and Suhas Nafday and Kathleen Gibbs and Robert Angert and Aryeh Simmonds and Furdon, {Susan A.} and Lisa Saiman and Lynn Spilman and Susan Boynton and Rebecca O'Donnell and Evelyn DePerna and Randi Wasserman and Yang Kim and Poslyn Mayers and Zina Jones and Larry Colbert and Kavita Kasat and Suzanne Monteleone and Collura, {Gloria M.} and Christine Grippi and Eileen Mulligan and Margaret Lang and Michelle Bode and Dave Martin and Penny Fuller and Angela Shtern and Jaime Fernandez and Margaret Moylan and Alok Bhutada and Shantanu Rastogi and Anna Sullivan and Nafday, {Suhas M.} and Campbell, {Deborah E.} and Herring, {Lucille H.} and Audrey Adams and Bernard Goldwasser and Ramona Karam-Howlin and Hendricks-Munoz, {Karen D.} and Caprio, {Martha C.} and Joan Cutrone and Michelle DeSomma and Steven Bock and David Bateman and Jennifer Duchon and Diane Carp and Philip Graham and Perlman, {Jeffrey M.} and Mary McCready and Claudette Theuriere and Ross, {Barbara G.} and Deborah Perlmutter and Claire Nagle and Vivian Smith and Schanler, {Richard J.} and Debra Potak and Hyacinth Hoey and Valencia, {Gloria B.} and Lahage, {Nadine E.} and Shanthy Sridhar and Adriann Combs and Michael Cicale and Francina Singh and Patricia Mele and Barbara Clones and Clare Nugent and Heather Brumberg and Venkata Majjiga and Boriana Parvez and Lita Isaacson and Jackie Krumholz and Alice Nash and Ralph Wynn and Linda Eschberger and Kathy Bean and Nancy Elmore and Gase, {Kathleen A.}",
year = "2011",
month = "3",
doi = "10.1542/peds.2010-2873",
language = "English (US)",
volume = "127",
pages = "436--444",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "3",

}

TY - JOUR

T1 - Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists

AU - Schulman, Joseph

AU - Stricof, Rachel

AU - Stevens, Timothy P.

AU - Horgan, Michael

AU - Gase, Kathleen

AU - Holzman, Ian R.

AU - Koppel, Robert I.

AU - Nafday, Suhas

AU - Gibbs, Kathleen

AU - Angert, Robert

AU - Simmonds, Aryeh

AU - Furdon, Susan A.

AU - Saiman, Lisa

AU - Spilman, Lynn

AU - Boynton, Susan

AU - O'Donnell, Rebecca

AU - DePerna, Evelyn

AU - Wasserman, Randi

AU - Kim, Yang

AU - Mayers, Poslyn

AU - Jones, Zina

AU - Colbert, Larry

AU - Kasat, Kavita

AU - Monteleone, Suzanne

AU - Collura, Gloria M.

AU - Grippi, Christine

AU - Mulligan, Eileen

AU - Lang, Margaret

AU - Bode, Michelle

AU - Martin, Dave

AU - Fuller, Penny

AU - Shtern, Angela

AU - Fernandez, Jaime

AU - Moylan, Margaret

AU - Bhutada, Alok

AU - Rastogi, Shantanu

AU - Sullivan, Anna

AU - Nafday, Suhas M.

AU - Campbell, Deborah E.

AU - Herring, Lucille H.

AU - Adams, Audrey

AU - Goldwasser, Bernard

AU - Karam-Howlin, Ramona

AU - Hendricks-Munoz, Karen D.

AU - Caprio, Martha C.

AU - Cutrone, Joan

AU - DeSomma, Michelle

AU - Bock, Steven

AU - Bateman, David

AU - Duchon, Jennifer

AU - Carp, Diane

AU - Graham, Philip

AU - Perlman, Jeffrey M.

AU - McCready, Mary

AU - Theuriere, Claudette

AU - Ross, Barbara G.

AU - Perlmutter, Deborah

AU - Nagle, Claire

AU - Smith, Vivian

AU - Schanler, Richard J.

AU - Potak, Debra

AU - Hoey, Hyacinth

AU - Valencia, Gloria B.

AU - Lahage, Nadine E.

AU - Sridhar, Shanthy

AU - Combs, Adriann

AU - Cicale, Michael

AU - Singh, Francina

AU - Mele, Patricia

AU - Clones, Barbara

AU - Nugent, Clare

AU - Brumberg, Heather

AU - Majjiga, Venkata

AU - Parvez, Boriana

AU - Isaacson, Lita

AU - Krumholz, Jackie

AU - Nash, Alice

AU - Wynn, Ralph

AU - Eschberger, Linda

AU - Bean, Kathy

AU - Elmore, Nancy

AU - Gase, Kathleen A.

PY - 2011/3

Y1 - 2011/3

N2 - 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.

AB - 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.

KW - Benchmarking

KW - Catheter-related infections

KW - Health care evaluation

KW - Infant

KW - Newborn

KW - Quality of health care

UR - http://www.scopus.com/inward/record.url?scp=79952225178&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952225178&partnerID=8YFLogxK

U2 - 10.1542/peds.2010-2873

DO - 10.1542/peds.2010-2873

M3 - Article

C2 - 21339265

AN - SCOPUS:79952225178

VL - 127

SP - 436

EP - 444

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 3

ER -