AHRQ project reduces bloodstream infections in newborns by 58%

Central line associated bloodstream infections in newborns were reduced by 58 percent in less than a year in hospital neonatal intensive care units (NICUs) participating in an Agency for Healthcare Research and Quality patient safety program. Frontline caregivers in 100 NICUs in nine states relied on the program's prevention practice checklists and better communication to prevent an estimated 131 infections and up to 41 deaths and to avoid more than $2 million in healthcare costs.

Central line associated bloodstream infections are healthcare-associated infections (HAIs) that cause serious illness and death in infants as well as adults. In newborns, especially premature infants, central lines can remain in place for weeks or months to provide nutrients and medications as babies become able to function on their own.

Healthcare teams in the project states, caring for a total of 8,400 newborns, used AHRQ's Comprehensive Unit-based Safety Program (CUSP) to improve safety culture and consistently implement catheter insertion and maintenance guidelines. This 11-month project used CUSP to help clinical teams focus on safe practices and appropriate steps when using central lines based on guidelines from the Centers for Disease Control and Prevention.

Each state-based team was led by a neonatologist who worked with the state's hospital association to implement the project, according to AHRQ. When the project began, participating NICUs had an overall infection rate of 2.043 per 1,000 central line days. At the end of the project, that rate was reduced to 0.855 per 1,000 central line days, a relative reduction of 58 percent.

"The CUSP framework brings together safety culture, teamwork and best practices—a combination that is clearly working to keep these vulnerable babies safer," says AHRQ Director Carolyn M. Clancy, MD. "These remarkable results show us that, with the right tools and dedicated clinicians, hospital units can rapidly make care safer."

The nine-state project in NICUs is part of a larger AHRQ-funded effort to implement CUSP to prevent central line associated bloodstream infections across the U.S. Preliminary results of the larger project were announced in September 2012; final results from the national implementation project are now available and show that central line associated bloodstream infections were reduced by 41 percent in adult ICUs. The final report is available online at the AHRQ website.

AHRQ provided funding to the Health Research & Educational Trust, the educational arm of the American Hospital Association, to conduct both projects. For the NICU project, HRET partnered with the Perinatal Quality Collaborative of North Carolina and the Missouri Center for Patient Safety to support Colorado, Florida, Hawaii, Massachusetts, Michigan, New Jersey, North Carolina, South Carolina and Wisconsin.