767 - Sustained CLABSI Reduction in a Level IV NICU Through Insertion & Maintenance Bundle Reliability with CHG Bathing and Audit Changes: Jan 2020–September 2025

Publication Number: 1743.767

Zohaib Sayyed, Connecticut Children's Medical Center, Manchester, CT, United States; Laura Lissner, Connecticut Children's Medical Center, Hartford, CT, United States; David Sink, University of Connecticut School of Medicine, West Hartford, CT, United States

Background: Central line-associated bloodstream infections (CLABSI) are a leading source of preventable harm in the NICU. Our NICU experienced an increase in CLABSI in 2022. We examined CLABSI trends and bundle reliability before and after targeted interventions: standardized chlorhexidine gluconate (CHG) bathing and bundle / audit refinements.

Objective: To determine if implementation of standardized CHG bathing and line insertion and maintenance bundle refinements and audits were associated with a reduction in CLABSI rate.

Design/Methods: Single-center, retrospective QI analysis in a Level IV NICU (Jan 2020-September 2025). The primary outcome measure was monthly LCBI CLABSI per 1,000 line-days. Process measures reflecting QI interventions included monthly rate of CHG baths performed when indicated and completion of insertion bundle checklist in real time.

Baseline period: Jan 2020-Sep 2022

Washout/Roll-out period: Oct 2022-Jan 2023. New bundle implemented including;
1. Use of CHG in preterm neonates (if < 37 wk, initiate when age ≥ 2 wk and weight ≥ 1500 g and PMA ≥ 30 wk),
2. CHG bathing, daily for >48 wk PMA with a central line, or twice weekly for ≥37 wk, or PMA 36 wk and age ≥ 2 wk and ≥1500 g),
3. Launched daily central-line audits and expanded hand-hygiene auditing.

Sustain period: Feb 2023-Sept 2025.

Results: Across Jan 2020-Sept 2025, there were 12 LCBI over 15,903 line-days (CLABSI rate: 0.75/1,000). Outcomes for each period:
Baseline: 7 events / 7597 line-days → 0.92/1,000
Washout: 0 events / 773 line-days → 0.00/1,000
Sustain: 5 events / 7,533 line-days → 0.66/1,000

Insertion bundle reliability remained high across phases (mean % compliance): Baseline 98.1%, Washout 95.0%, Sustain 97.4%. CHG bath compliance was high in sustain period 97.8% and insertion bundle audit compliance was 100%. Statistical Process Control analysis of monthly CLABSI rate showed special cause variation with decrease in centerline CLABSI rate in June 2023 from 1.86 to 0.61 (Figure 1). Monthly CHG bathing rate showed special cause variation in July 2023 (Figure 2). Monthly compliance with line insertion checklist completion increased in March 2024, from 0.94 to 0.96 (Figure 3).

Conclusion(s): Following CHG standardization and insertion bundle audit refinements, the unit achieved and sustained a lower CLABSI rate compared with Baseline (from 0.92 to 0.66 per 1,000 line-days in Sustain) while maintaining high insertion bundle reliability. The Washout interval showed no events. Trends support that consistent checklist use and CHG bathing roll-in contributed to a durable reduction in LCBI.

LCBI/CLABSI events / 1000 Line days u Chart
Figure 1: Monthly CLABSI rate per 1000 central line days, u chart

CHG bathing Performed - X chart
Figure 2: Monthly performance of CHG bathing, X chart

Insertion Checklist completion - p chart
Figure 3: Monthly audits of Insertion Checklist completion, p chart