• Article
  • November 29, 2017

How a Group of Children's Hospitals Reduced CLABSI Rates by 64 Percent

Hospitals that used a sterile tubing change technique saw the biggest decline in rates.

Preventing central line-associated bloodstream infections (CLABSIs) is a top priority for children's hospitals—and for good reason. According to the National Center for Biotechnology Information, CLABSIs are the leading type of device-associated infections among patients in neonatal intensive care units (NICUs). Newly published research shows some promising gains hospitals are making in CLABSI prevention.

A quality improvement initiative conducted by the Standardizing Line care Under Guideline recommendations (SLUG Bug) collaborative—a partnership of more than a dozen children's hospitals aimed at reducing preventable bloodstream infections in neonatal patients—has shown substantial declines in CLABSIs. Notably, hospitals that transitioned to a sterile tubing change (TC) technique in which sterile gloves and a mask were used with a sterile barrier under the central venous catheter,  reported a 64 percent decrease in CLABSI rates.

"One of the exciting points is that these participating centers already had low infection rates," says Eugenia Pallotto, M.D., M.S.C.E, the medical director of the NICU at Children's Mercy Kansas City and a co-author of the study published in Pediatrics. "But by continuing to work on this together, they were able to achieve even lower rates."

No "magic bullet"

The Children's Hospitals Neonatal Consortium formed the SLUG Bug collaborative in 2011 with 17 NICUs participating. The collaborative examined a number of CLABSI prevention methods, and during the initial one-year research period experienced a drop in CLABSI rates of about 20 percent. That success was sustained during the second phase of the study, in the nearly two years that followed.

The four centers that transitioned to the TC technique during this sustain phase saw CLABSI rates plummet from 1.59 CLABSIs per 1,000 line days to 0.57 CLABSIs per 1,000 line days. Impressive results, but Pallotto says there's more to improving infection rates than any one CLABSI prevention technique.

"There's not one magic bullet to lowering infections—it's the culture of infection prevention that is important," Pallotto says. "Centers have to look at all the different possibilities and highlight practices that could be additive at their site—it's a combination of a lot of things."

Collaboration is key

Pallotto says it can require a culture shift, from hospital leadership to the care teams, to affect this type of change in infection rates. But the intensive collaboration among SLUG Bug member centers—with activities that included learning sessions, monthly webinars, a listserv and quality improvement advisors—can't be overstated.

"It makes a huge difference because we can learn what other centers are doing that's working, how they overcome barriers, how they educate and teach a practice," Pallotto says. "That sharing of information is great for all the teams."

Send questions or comments to magazine@childrenshospitals.org.