From lines to lifelines: a quality improvement study to reduce CLABSI at a level III NICU in LMIC

BACKGROUND: Central line-associated bloodstream infection (CLABSI) is a major contributor to morbidity and mortality among neonates admitted to the neonatal intensive care unit (NICU). Point-of-care quality improvement (POCQI) methods can reduce the rate of CLABSI by improving compliance with the care bundle. METHODS: A quality improvement study comprising three phases was planned in the NICU of a tertiary care hospital in western India to assess the impact of the central line care bundle. Baseline data were collected for 8 weeks to find the incidence of CLABSI. An aim statement was made and a team formed. A root cause analysis was conducted to identify the factors contributing to the high rate of CLABSI. Various changed ideas were tested in plan-do-study-act cycles and monitored with process indicators. Ideas were adopted or adapted based on their impact. Compliance with insertion and maintenance bundles was used as a process indicator, while the CLABSI rate served as an outcome indicator. RESULTS: CLABSI rate reduced from 66/1000 catheter days (May 2023) to 18/1000 catheter days (95% CI 0.14 to 0.79; p value 0.012) during the study. Insertion bundle compliance increased to 85% during the intervention phase and 70% during the sustainability phase. Maintenance bundle compliance was 45% and 35% during the intervention and sustainability phases, respectively. CONCLUSION: POCQI methods can help increase bundle care compliance in the NICU and reduce CLABSI rates in low- and middle-income country settings.