Compliance with prevention practices and their association with central line-associated bloodstream infections in neonatal intensive care units

Abstract

Background: Bundles and checklists have been shown to decrease the rates of central line-associated bloodstream infections (CLABSIs), but implementation of these practices and association with CLABSI rates have not been described nationally. We describe implementation and levels of compliance with preventive practices in a sample of US neonatal intensive care units (NICUs) and assess their association with CLABSI rates.

Methods: An online survey assessing infection prevention practices was sent to hospitals participating in National Healthcare Safety Network CLABSI surveillance in October 2011. Participating hospitals permitted access to their NICU CLABSI rates. Multivariable regressions were used to test the association between compliance with NICU-specific CLABSI prevention practices and corresponding CLABSI rates.

Results: Overall, 190 level II/III and level III NICUs participated. The majority of NICUs had written policies (84%-93%) and monitored compliance with bundles and checklists (88%-91%). Reporting ≥95% compliance for any of the practices ranged from 50%-63%. Reporting of ≥95% compliance with insertion checklist and assessment of daily line necessity were significantly associated with lower CLABSI rates (P < .05).

Conclusions: Most of the NICUs in this national sample have instituted CLABSI prevention policies and monitor compliance, although reporting compliance ≥95% was suboptimal. Reporting ≥95% compliance with select CLABSI prevention practices was associated with lower CLABSI rates. Future studies should focus on identifying and improving compliance with effective CLABSI prevention practices in neonates.

Keywords: Bundles; CLABSI; Neonate.