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Journal of Pregnancy and Newborncare


Research Article

The Implementation of Central Line Associated Blood Stream Infection Prevention Bundles in Neonatal Intensive Care Unit: A Collaborated Multidisciplinary Approach

Motlhoki Lillian Dikeledi* and Qaraqei Mustafa

Correspondence Address :

Motlhoki Lillian Dikeledi,
Faculty of Medicine and Health Sciences,
King Fahad Medical City, Research Centre,
Children's Specialized Hospital, Dabbab Street, Riyadh,
Kingdom of Saudi Arabia.

Received on: 15 February 2021, Accepted on: 19 February 2021, Published on: 22 February 2021

Citation: Motlhoki Lillian Dikeledi, Qaraqei Mustafa (2021). The Implementation of Central Line Associated Blood Stream Infection Prevention Bundles in Neonatal Intensive Care Unit: A Collaborated Multidisciplinary Approach

Copyright: 2021 Motlhoki Lillian Dikeledi, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  • Abstract


Background: Central line-associated blood stream infections (CLABSIs) are largely related to Healthcare Associated Infections (HAIs) among Neonatal Intensive Care units (NICUs) [1-5]. Preventing CLABSIs in NICUs requires a collaborated multidisciplinary approach in ensuring adherence CLABSI prevention bundles by all multidisciplinary teams in NICU [15]. CLABSIs contribute to 12% to 25% of mortality rate among NICU patients [1-3]. It also increases length of stay and costs of care of patients in NICU [1-10]. There is a need for commitment and collaboration among multidisciplinary teams in NICU in preventing CLABSI [15].
Methods: A descriptive cross sectional study was conducted through utilization of structured self administrative questionnaire. Prospective quality improvement interventions that reduce CLABSI were implemented. That included implementation and maintenance of CLABSI prevention bundles, provision of education and training of Healthcare workers (HCWs) in NICU about CLABSI bundles, and the best strategies in managing it, development of forms, toolkits and policies related to CLABSI. Participants in this research composed of NICU multidisciplinary team, namely: Permanent medical and nursing staff assigned in NICU and others i.e assigned Infection control practitioner, link representation for CLABSI, medical supply representation assigned in NICU, Quality improvement practitioner and NICU Head of the Department. Regular meeting were held with multidisciplinary team and collaboration with all stake holders in NICU. The main driver in achieving positive results for prevention of CLABSI was through effective utilization of CLABSI prevention bundle. That was enhanced further by ensuring teamwork, commitment among all teams in NICU, interdisciplinary coaching, communication, learning and information sharing, monitoring, review and provision of feedback among NICU HCWs, Infection control department teams, and others. Rate of CLABSI and central line utilization ratios in NICU was observed for a period of one year and two months (From March 2017 until May 2018), which includes three months of pre intervention, six months of implementation and five months post intervention.

Results: Data reviled the following: Overall , the results reviled significant reduction of CLABSI rates from 7.0 per 1000 central line days to 2.1 per 1000 central from pre intervention to during intervention phase (p<0.001) and from 2.1 to 1.7 per 1000 central line days post intervention. Central line utilization (CLUR) ratio, which is central line days to bed days, also decreased between pre and post intervention phase from 0.57 to 0.51 (p<0.001). Results indicated reduction in CLABSI rate and increased compliance in CLABSI bundle utilization among NICU HCWs. That was further enhanced by multidisciplinary collaboration and communication among teams assigned in NICU.

Conclusions: Research findings in this study reviled that ,the implementation of a collaborated multidisciplinary approach on Central Line Associated Blood Stream Infection (CLABSI) prevention bundles among multidisciplinary teams in NICU may yield tremendous decrease in CLABSI rate. However ensuring effective and efficient patients ‘safety, sustainability in the reduction of CLABSI in NICU requires more commitment, communication and collaboration among HCWs in NICU [15].

Keywords: Central line-associated blood stream infection, Neonatal Intensive care unit, collaborated multidisciplinary approach, Central line utilization ratio, Central venous catheter