Eliminating CLABSI, A National Patient Safety Imperative: Neonatal CLABSI Prevention

On the CUSP: Stop BSI project provided funding to improve culture and prevent central line blood stream infections in U.S. hospitals—mainly in adult intensive care units. In August 2011, the Health Research & Educational Trust (HRET), partnering with the Perinatal Quality Collaborative of North Carolina (PQCNC), implemented a national, neonatal central line-associated bloodstream infection (NCLABSI) reduction project specifically focused in Neonatal Intensive Care Units (NICU). CLABSI is a significant contributor to morbidity and mortality for infants. This population is specifically susceptible to infections because of immature immune systems. While many NICUs no longer view these infections as inevitable, NICUs confront a range of unique obstacles in the work to eliminate CLABSI. For example, premature infants require intravenous access until they can tolerate enteral feedings which for extremely premature infants can take several weeks, if not months to accomplish.

Leveraging existing State-based neonatal networks, nine States were recruited into this NCLABSI project: Colorado, Florida, Hawaii, Massachusetts, Michigan, New Jersey, North Carolina, South Carolina, and Wisconsin. Each neonatal State-based network was led by a neonatologist, also referred to as a State clinical lead. These State clinical leads worked with their State hospital associations and recruited NICUs to participate, submit CLABSI data to PQCNC for real-time feedback, and engage unit teams to improve safety culture using the Comprehensive Unit-Based Safety Program (CUSP).

The project had two primary aims:

1. Create and support nine statewide CLABSI collaboratives committed to reducing CLABSI.
2. Improve safety culture.

With a condensed project time line, each State was asked to develop a State consortium that included providers (neonatologists, nurses, nurse practitioners, infection control professionals [ICPs]), State leaders such as Departments of Public Health (DPH), payers (Medicaid and other significant payers) and family organizations.

The NCLABSI project model differed from the adult On the CUSP: Stop BSI model in that:

1. The State leads were neonatologists, not employed by a State hospital association.
2. Education on CUSP was provided by the Missouri Center for Patient Safety, not Johns Hopkins University.
3. Data was collected by PQCNC, not Michigan Health and Hospital Association’s Keystone Center for Patient Safety.
4. The technical intervention focused more on maintenance than insertion given the clinical considerations of NICU populations.
5. The implementation timeline was shortened.