Am J Perinatol 2020; 37(S 02): S14-S17
DOI: 10.1055/s-0040-1713605
Review Article

Quality Improvement to Reduce Neonatal CLABSI: The Journey to Zero

Stephen A. Pearlman
1   Department of Pediatrics, ChristianaCare, Newark, Delaware
2   Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
› Author Affiliations


Neonatal infections, including those associated with central lines, continue to be a major cause of morbidity and mortality despite many other improvements in neonatal outcomes. Over the past decades, significant advances have been made to reduce central line-associated bloodstream infections (CLABSIs) using quality improvement methodology. This article will review pertinent studies that used both the Institute for Healthcare Improvement Model for Improvement and other innovative techniques such as orchestrated testing and health care failure mode and effects analysis. These studies, by applying best practices, have demonstrated substantial and sustainable reductions in CLABSI. Some initiatives have been able to achieve rates of zero CLABSI for prolonged periods of time. While neonates often require prolonged central venous access and suffer from impaired immunity which increases the risk of CLABSI, this review demonstrates the journey to zero is feasible.

Key Points

  • Quality improvement methods are effective to reduce CLABSI.

  • Improvement strategies vary by setting.

  • Achieving zero CLABSI rates is possible.

Publication History

Article published online:
08 September 2020

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

  • References

  • 1 Chandonnet CJ, Kahlon PS, Rachh P. , et al. Health care failure mode and effect analysis to reduce NICU line-associated bloodstream infections. Pediatrics 2013; 131 (06) e1961-e1969
  • 2 Hornik CP, Fort P, Clark RH. , et al. Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units. Early Hum Dev 2012; 88 (Suppl. 02) S69-S74
  • 3 Bizzarro MJ, Raskind C, Baltimore RS, Gallagher PG. Seventy-five years of neonatal sepsis at Yale: 1928-2003. Pediatrics 2005; 116 (03) 595-602
  • 4 Piazza AJ, Brozanski B, Provost L. , et al. SLUG Bug: quality improvement with orchestrated testing leads to NICU CLABSI reduction. Pediatrics 2016; 137 (01) e20143642
  • 5 Kohn LT, Corrigan J, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington DC: National Academy Press; 2000
  • 6 Pronovost P, Needham D, Berenholtz S. , et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355 (26) 2725-2732
  • 7 Sengupta A, Lehmann C, Diener-West M, Perl TM, Milstone AM. Catheter duration and risk of CLA-BSI in neonates with PICCs. Pediatrics 2010; 125 (04) 648-653
  • 8 Dahan M, O'Donnell S, Hebert J. , et al. CLABSI risk factors in the NICU: potential for prevention: a PICNIC study. Infect Control Hosp Epidemiol 2016; 37 (12) 1446-1452
  • 9 Blanchard AC, Fortin E, Rocher I. , et al. Central line-associated bloodstream infection in neonatal intensive care units. Infect Control Hosp Epidemiol 2013; 34 (11) 1167-1173
  • 10 Zhou Q, Lee SK, Hu X-J. , et al. Successful reduction in central line-associated bloodstream infections in a Chinese neonatal intensive care unit. Am J Infect Control 2015; 43 (03) 275-279
  • 11 Wirtshafter DD, Pettit J, Kurtin P. , et al. A statewide collaborative to reduce neonatal central line-associated bloodstream infections. J Perinatol 2010; 30: 170-181
  • 12 Bizzarro MJ, Sabo B, Noonan M, Bonfiglio MP, Northrup V, Diefenbach K. Central Venous Catheter Initiative Committee. A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2010; 31 (03) 241-248
  • 13 Ting JY, Goh VSK, Osiovich H. Reduction of central line-associated bloodstream infection rates in a neonatal intensive care unit after implementation of a multidisciplinary evidence-based quality improvement collaborative: a four year experience. Can J Infect Dis Med Microbiol 2013; 24 (04) 185-190
  • 14 Shepherd EG, Kelly TJ, Vinsel JA. , et al. Significant reduction of central-line associated bloodstream infections in a network of diverse neonatal nurseries. J Pediatr 2015; 167 (01) 41-6.e1 , 3
  • 15 Zachariah P, Furuya EY, Edwards J. , et al. Compliance with prevention practices and their association with central line-associated bloodstream infections in neonatal intensive care units. Am J Infect Control 2014; 42 (08) 847-851
  • 16 Lee CS, Larson DB. Beginner's guide to practice quality improvement using the model for improvement. J Am Coll Radiol 2014; 11 (12 Pt A): 1131-1136
  • 17 Tuttle DJ, Pearlman SA, Mackley AB. , et al. Performance improvement reduces peripheral long line CLABSI in preterm infants. Pediatr Res 2011; 11: 65-68
  • 18 Reder A. Seven Years, Zero CLABSIs: How a California Hospital Did It. Patient Safety and Quality Healthcare 2013. Available at: . Accessed March 17, 2020
  • 19 Erdei C, McAvoy LL, Gupta M, Pereira S, McGowan EC. Is zero central line-associated bloodstream infection rate sustainable? A 5-year perspective. Pediatrics 2015; 135 (06) e1485-e1493