Reduction in Central Line Associated Blood Stream Infection (CLABSI) rate in a tertiary level Neonatal Intensive Care Unit through a Quality Improvement Initiative.

all neonates admitted in NICU in whom central line is place in NICU will be included in study. Observational study using WHO Point of Care Quality Improvement Model, using Plan–Do–Study–Act (PDSA) cycles approach. The duration of the QI is a 3 months baseline phase followed by 6 months of implementation which will be undertaken in the form of Plan-Do-Study-Act (P-D-S-A) cycles. The sustenance phase is for 9 months.  Root cause analysis will be done by FISH BONE ANALYSIS and Process Flowchart for identifying the possible causes of CLABSI in the unit. This will be followed by PDSA cycles for improving the process of care and developing a care bundle. Data will be plotted on RUN charts. A QI team will be formed involving one NICU consultant, one microbiologist, NICU in-charge nursing staff, 1 NICU senior resident, 1 NICU infection control sister, 1 quality control sister. The study will be conducted in 3 phases. 1) Pre-implementation phase - All patients with central line in place for more than 48 hours, with day of line placement as day 1, will be enrolled and followed-up until either transfer from NICU to step-down unit, discharge or death. Compliance during CL insertion and maintenance will be observed. Hand hygiene compliance will be observed. 2 Implementation phase - The educational sessions of nursing staff and resident doctors will be done which will include definition of CLABSI, preventive measures and explanation of project bundles, procedures and forms. Compliance with insertion and improving of processes will be done using PDSA. Changes will be either adopted or abandoned as study will progress. Staff meetings will be held to discuss the non-compliances. One PDSA cycle for 2-4 weeks will be done. Changes will be done in strategies depending on results at the end of each cycle. Accordingly multiple PDSA cycles will be done over the period of 6 months. 3) Sustenance phase- For next 9 month period, all patient with CL in place for >48 hours with day of line placement as day 1, will be enrolled The following data will be recorded for all patients: Data regarding GA, CA, birth wt. and current wt., place of birth, duration of NICU stay, brief clinical history along with date, time and reason for insertion and removal will be recorded. Duration for each line will also be recorded. Line day at which CLABSI is confirmed will also be noted. All data will be collected by a NICU team. The process indicators will be based on hand hygiene (audits per month) and central line care audits (audits per month). Outcome measures and process indicators CLABSI /1000 line days BSI /1000 patient days Line days/1000 patient days