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Decrease CLABSI &

Maintain low CLABSI rate
in North Carolina
Sigal Peter-Wohl MD
Associate Professor of Pediatrics
UNC Neonatal-Perinatal Medicine
Initiative Background

2009-2010 NC CABSI Action Plan
• 3 webinars
• Insertion Bundle
– Time out, hand hygeine, sterile precautions, sterile barrier,
skin prep
• Maintenance Bundle
– Enteral feeds (120 cc/k/d), rounds discussion re line,
dressing change, skin prep, scrub the hub
Initiative Background

2009-2010 NC CABSI Time-Line
– June-July 2009: Three expert team webinars to develop action plan.
Chaired by Dr. David Fisher.
– September 2009: Learning session for all teams (13) to review
evidence and develop goals/action plan
– October 2009: Data collection began, sites beginning to test changes.
– December 2009: PQCNC annual meeting, half of teams attended and
participated in “town meetings.”
– March 2010: Regional meeting
– October 2009-July 2010: All team monthly webinars
– August 2010: Final learning session
Initiative Background

Fisher D et al. Central Line Associated Bloodstream Infections in North Carolina NICUs.
Pediatrics. 2013 Dec;132(6):e1664-71

Result:
• 13 NICUs
• Monthly NICU Demographic Data Collection
– 78,967 total patient days
– 26,499 total catheter days
– 52,998 total catheter shifts
• Insertion Data
– 1209 Catheters
• Maintenance Data
– 17,008 line observations (observation from 36% of all catheter shifts)
Initiative Background

Fisher D et al. Central Line Associated Bloodstream Infections in North Carolina NICUs.
Pediatrics. 2013 Dec;132(6):e1664-71

• Sustained 75% reduction
in CLABSI with NHSN
data 2010-2011
• Avoid 98 infections
annually in NC
• Saved 12 lives a year
• Since 2009 48 lives
saved, 392 infections
avoided, $8M saved
• NC NICU CLABSI rate top
10%
Initiative Background

National CLABSI
• Partnership with AHA/AHRQ
• Multistate NICU CLABSI initiative
– 9 States
– 91 NICUs
• Action Plan similar to NC CLABSI initiative
– Insertion/Maintenance Bundles
– CUSP
• Result:
– 38,892 Line Insertion Observations
– 202,398 Maintenance Observations
• 54% reporting overall
– 371,862 NHSN Line Days
Initiative Background

• Achieved a 58%
reduction in NCLABSI
rates
• An estimated 131
infections were
prevented
• Translates to an
estimated 14 – 41
deaths prevented
• $2,201,776 in excess
costs averted
Initiative Background

Fisher D et al. Central Line Associated Bloodstream Infections in North Carolina NICUs.
Pediatrics. 2013 Dec;132(6):e1664-71

Result:
• 13 NICUs
• Monthly NICU Demographic Data Collection
– 78,967 total patient days
– 26,499 total catheter days
– 52,998 total catheter shifts
• Insertion Data
– 1209 Catheters
• Maintenance Data
– 17,008 line observations (observation from 36% of all catheter shifts)
Initiative Background

Current NC CLABSI State:
• From the Healthcare-Associated Infections in
North Carolina 2017 Annual Report
• National goal from HHS of 0.5 SIR
• Comparing 2015 to 2017 data
• SIR is obs/expected numbers of infections
• Regression analysis of data includes birth
weights (< 750, 751-1000, 1001-1500, >1500
NC Academic Centers
NC Hospitals 400 or More Beds
Current NC CLABSI Data
• Hospitals with 100-199 beds and
400+ beds reported the same
number of CLABSIs as predicted,
performing the SAME as the 2015
national experience
• Hospitals with a primary medical
school affiliation reported fewer
CLABSIs in NICUs than predicted,
performing BETTER than the 2015
national experience
• In 2017, Staphylococcus aureus
(27%), was the most common
pathogen identified from CLABSIs
in NICU locations
Initiative Aims
• NC NICUs as a whole currently have not met the
target for HHS CLABSI (SIR 0.5) rates
–FIRST GOAL: achieve target for HHS
CLABSI rates in all NICUs in the state
• NC NICUs in 2009-2013 made great strides in local
and national CLABSI projects, but most NICUs
experienced increase in CLABSI rates since
–SECOND GOAL: be able to maintain this
target
Why a CLABSI Proposal
• We have experience and variation still
exists
• We have previously developed action
plans for line insertion and maintenance
• We have large centers of excellence to
continue to learn from who have
achieved and sustained reduced central
line days
Initiative Reach

• The project needs to include all NICUs
across the state
• Only 13 participated previously
• As many as 26 NICUs might now
participate
Initiative Impact

Given the association of NEC, CLD,
Developmental outcome and CLABSI, there
is a potential to impact significantly
premature infant morbidity and mortality
Supporting Materials

• Fisher D et al. Central Line Associated Bloodstream Infections in North
Carolina NICUs. Pediatrics. 2013 Dec;132(6):e1664-71
• National CLABSI data:
• Current NC data: from: Healthcare-Associated Infections in North Carolina
2017 Annual Report