On the CUSP: STOP BSI
NCLABSI: The NICU Collaborative
Neonatal intensive care units (NICUs) participating in the AHRQ-funded patient safety program NCLABSI: The NICU Collaborative successfully reduced central line-associated bloodstream infections (CLABSI) in newborns by 58 percent in less than one year. Participating NICUs had an overall infection rate of 2.043 per 1,000 central line days when the project began. At the end of the project, that rate was reduced to 0.855 per 1,000 central line days, a relative reduction of 58 percent.
CLABSI is a significant contributor to morbidity and mortality for infants receiving NICU care. While many NICUs no longer view these infections as inevitable, NICUs confront a range of unique obstacles in the work to eliminate CLABSI. For example, expertise in health care quality varies widely among NICU settings, and NICUs experience fatigue brought about by an ever-expanding menu of quality improvement activities required of hospitals.
Funded under the same AHRQ contract as the adult On the CUSP: Stop BSI project, a related but different “NCLABSI” collaborative model focused in NICUs took place in nine states: Colorado, Florida, Hawaii, Massachusetts, Michigan, New Jersey, North Carolina, South Carolina, and Wisconsin. Recognizing that CLABSI prevention for infants differs from that of adults, the Health Research & Educational Trust (HRET) and the Perinatal Quality Collaborative of North Carolina (PQCNC) launched this collaborative in August 2011 with the nine state leads being neonatologists and clinicians. These state clinical leads worked with their state hospital associations and recruited NICUs to participate, submitted CLABSI data to PQCNC for real-time feedback, and engaged unit teams to assess and continually address safety culture through the Comprehensive Unit-based Safety Program (CUSP).
The project had two primary aims:
1. Create and support a minimum of eight statewide CLABSI collaboratives committed to reducing CLABSI by 75 percent.
2. Each state developed a leadership team that provided a foundation for a stakeholder collaborative organization that included providers (neonatologists, nurses, nurse practitioners, ICPs), state leaders (DPH), payers (Medicaid and other significant payers), and family organizations.
The NCLABSI NICU Collaborative achieved impressive results: a 58 percent drop in CLABSI rates in less than one year. Frontline caregivers in 100 NICUs in the nine participating states prevented an estimated 131 infections and up to 41 deaths and avoided more than $2 million in health care costs. Read the final AHRQ report to learn more.