A protocol for quality improvement programme to reduce central line-associated bloodstream infections in NICU of low and middle income country

Abstract

IntroductionCentral line-associated bloodstream infections (CLABSI) are the most important cause of morbidity and mortality in critically ill patients. Evidence-based interventions when used in form of a bundle have proven to decrease CLABSI. Our unit has a high CLABSI rate (9/1000 central line days). Therefore, we intend to introduce evidence-based CLABSI prevention package in our practice to improve CLABSI rates in our NICU within limited resources.Methods and analysisThe study will be conducted using preanalysis and postanalysis design from January 2016 to December 2017. It is going to be conducted in three phases with phase I being the preimplimentation phase where retrospective data will be collected. Phase II, implementation phase, where the CLABSI prevention package will be introduced and phase III will be follow-up to see the impact. Primary outcome will be reduction in CLABSI rates.Analysis plan and reportingFor all three phases, descriptive analysis will be performed. Nominal data will be presented as mean±SD, whereas categorical data will be presented as frequencies and percentages. To compare the effect of intervention we will use independent sample t-test for continuous outcomes, whereas Χ2 test will be used for categorical outcomes. Relative risk ratios, 95% CI, and p values will be determined. Incidence density will be calculated and Poisson regression will be used to determine factors associated with incidence of CLABSI. Microbiological profiles and antimicrobial resistance pattern will be reported as pan sensitive, multidrug-resistant organism and carbapenem-resistant organism. SQUIRE V.2.0 guidelines will be used for manuscript writing and reporting.

Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases

“…During implementation of the preventive measures, limitations of human resources affect also the compliance with the prevention guidelines, as shown by a study in Jordan where the nurse to patient ratio of 1:1 was the only predictor of higher compliance with the guidelines (Aloush and Alsaraieh, 2018). Effective strategies may be used to overcome this challenge during interventions, including assigning a nurse as a unit-based quality nurse (Thom et al, 2014), or assembly of an intervention team of physician, infection control nurse, and ICU nurse to assess and follow up CLABSI cases (Hussain et al, 2017).…”

Improving clinical outcomes of very low birth weight infants

“…A previous study has demonstrated the role of using “Bundles” for controlling CLABSI [ 18 ]. In one study, the zero-sepsis rate for 1000 days was achieved and was attributed to adopting the “Bundle care approach.” [ 21 ] In another study by Asad Latif et al., the combined use of exclusive maternal milk and adopting Bundle care approach led to reduction in various morbidities including reduced rate of culture-positive sepsis in VLBW babies [ 9 ].…”

Peripherally inserted central catheters versus non-tunnelled ultrasound-guided central venous catheters in newborns: a retrospective observational study

“…The infection cannot be related to any other infection the patient might have and must not have been present or incubating when the patient was admitted to the facility. CLABSI rate is the total number of CLABSI divided by the total number of device days 1000 11 12…”