Compliance with international prevention guidelines for central-line-associated bloodstream infections in neonatal intensive care units in Belgium: a national survey

Abstract

Background: Central-line-associated bloodstream infections (CLABSIs) are a preventable cause of morbidity among patients in neonatal intensive care units (NICUs).

Aims: To assess compliance with international guidelines for prevention of CLABSIs in Belgian NICUs, and to study unit characteristics contributing to CLABSIs.

Methods: A survey was undertaken to measure the adherence of various NICUs to the CLABSI prevention guidelines related to catheter insertion, catheter maintenance and quality control measurements. A Poisson regression model was used to estimate the CLABSI adjusted relative risk for each prevention guideline item implemented. Multi-variable linear regression was used to estimate associations between guideline compliance rate and facility characteristics and the incidence of CLABSIs for 2015-2016.

Findings: In Belgium, the overall CLABSI incidence density was 8.48/1000 central-line-days, and was higher in larger NICUs: 10.87‰ vs 6.69‰ (P<0.05). Adherence was highest for prevention items at catheter insertion (64%), and low for catheter maintenance and quality control items (47% and 50%, respectively). Superior adherence to insertion items (P=0.051) and quality performance items (P=0.004) was associated with decreased risk of CLABSIs, but this was not found for maintenance prevention items (P=0.279). After adjustment for guideline adherence, the size of the NICU was found to be an independent determinant for CLABSIs (P=0.002).

Conclusions: In Belgium, the adherence of NICUs to international CLABSI prevention guidelines is moderate to poor. Compliance of NICUs with the guidelines is significantly associated with decreased CLABSI rates. The reasons for the gap between current practice in Belgian NICUs and international prevention guidelines need further investigation.

Keywords: Central-line-associated bloodstream infection (CLABSI); Guideline compliance; Neonatal intensive care unit (NICU); Newborn; Quality of health care.