99 - Reduction of CLABSIs in a LEVEL IV NICU Utilizing a Broadened Line Placement Algorithm

Publication Number: 4097.99

Sushmita Yallapragada, University of Texas Southwestern Medical School, Dallas, TX, United States; Rebecca Palmer, Children's Health, Fate, TX, United States; Tricia Boldt, Children's Health Dallas, Dallas, TX, United States; Charmaine Shaw, Children's Health, Forney, TX, United States; Courtney J. Campbell, UTSW, Frisco, TX, United States; Jeanne Gaines, Childrens Health Dallas, Dallas, TX, United States; Katie Doerge, Children's Health, Irving, TX, United States

Background: Central line-associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs), contribute to increased morbidity, mortality, and healthcare costs. Neonates are particularly vulnerable to CLABSIs due to their immature immune systems, prolonged hospital stays, and the invasive nature of central venous line (CVL) required for administering medications, nutrition, and fluids.
CLABSIs are influenced by several factors: duration of CVL, type of catheter, site of insertion, and adherence to infection prevention protocols. Preventative strategies, such as strict aseptic techniques during insertion, assessment of necessity, and implementation of evidence-based care bundles, have been established to reduce the incidence of CLABSIs. However, despite these measures, CLABSIs remain a leading cause of morbidity in neonatal patients.
Line utilization rates and therefore CLABSI rates in our NICU were high for a prolonged period of time. We put together a multidisciplinary team to address this issue from many angles, with particular emphasis on appropriate line placement.

Objective: To reduce CLABSI rate by 10% per year from 2023 to present.

Design/Methods: A dedicated multidisciplinary team of RNs, APPs, and MDs developed a central line algorithm to enhance decision-making in our Level IV NICU. We conducted thorough research to identify the most effective midline catheter brands, trained our RNs and APPs, and began implementing midlines across our unit. Utilizing the PDSA methodology, we rolled out this algorithm through educational sessions, emails, and in-person training. Over the past two years, we closely monitored central line utilization rates and tracked trends in CLABSI rates.

Results: CLABSI rates have seen a remarkable decline of 30% in the first year and nearly 50% from 2024 to 2025. Additionally, both line days and patient days have consistently decreased over the past two years.

Conclusion(s): Successfully reducing CLABSI in the NICU requires a multidisciplinary approach that includes developing line utilization algorithms and opting for midlines over central lines for specific patient populations.

Figure 1
Central line placement algorithm

Figure 2.
Demonstrates a steady decrease in rate of CLABSI over the last 2 years

Table 1.
Central line utilization rates over the last 5 years