776 - Reducing Coagulase-Negative Staphylococcus Positive Blood Cultures in the Neonatal Intensive Care Unit: A Multidisciplinary Approach

Publication Number: 1752.776

Patricia N. Moran, West Virginia University Children's Hospital, Morgantown, WV, United States; Meghan Handley, University of Virginia School of Medicine, Gordonsville, VA, United States; Sarah M. Lepore, UVA Health, Children's, Crozet, VA, United States; Ashley Walters, UVA Health, Charlottesville, VA, United States; David Kaufman, University of Virginia School of Medicine, Charlottesville, VA, United States; Megan Elliott, University of Virginia School of Medicine, Charlottesville, VA, United States; Jonathan R. Swanson, University of Virginia School of Medicine, Charlottesville, VA, United States

Background: Coagulase-negative staphylococcus (CoNS) commonly causes late-onset sepsis in neonates, particularly very low birth weight (VLBW) infants, with high potential for morbidity and mortality. CoNS can also be a contaminant in blood cultures, leading to diagnostic uncertainty, unnecessary antibiotic use and increased central line days. Our NICU had higher rates of CoNS infections (>75th %tile) compared to similar type institutions in the Vermont Oxford Network (VON). We hypothesized that inconsistent adherence to aseptic technique during blood culture collection-particularly when using the "one-stop shop" approach of drawing cultures during PIV placement-contributes to an elevated rate of CoNS positive cultures.

Objective: The primary aim was to decrease CoNS positive blood cultures in the NICU by 50%, from an average of 3.7 to 1.85 events per month, within one year by standardizing collection practices through team education, procedural changes, and implementation of a multidisciplinary sepsis huddle.

Design/Methods: Our primary outcome measure was the rate of CoNS events per month. Process measures included alcohol use as the antiseptic and a standardized culture collection checklist. Total blood cultures obtained and number of attempts per culture were tracked as balancing measures. PDSA 1-3 included introducing a nursing checklist, standardizing alcohol use, two-person culture collection, weekly central line rounds and nursing report-outs during rounds to promote early infection prevention. PDSA 4 eliminated the "one-stop shop" method and introduced a sepsis alert huddle to improve coordination and sterility in blood culture collection.

Results: We achieved a 70% reduction in the monthly CoNS event rate in our NICU, decreasing from an average of 3.7 to 1.13 events per month over 20 months. Initial PDSA cycles improved consistency and awareness but did not reduce CoNS rates. Special cause variation was identified following PDSA 4, which eliminated the "one-stop shop" collection method and initiated sepsis huddles. Despite checklist completion declining over time, there was sustained improvement in our primary outcome. Adherence to alcohol as an antiseptic was nearly 100%. Total cultures and attempts remained stable.

Conclusion(s): We achieved a 70% reduction in CoNS rates in our NICU through standardized collection practices, elimination of the "one-stop shop" method, and implementation of sepsis huddles. Future efforts will focus on maintaining improvements in sterile technique and enhancing documentation through a new EMR nursing flowsheet to support ongoing quality improvement.

CoNS Events per Month c Chart
Figure 1: Monthly CoNS events from March 2023 to July 2025 with PDSA 1-4 labeled to indicate implemented interventions.