Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Nov 28;13(12):386.
doi: 10.3390/diseases13120386.

Impact of an Evidence-Based Bundle on Catheter-Associated Sepsis Incidence in Neonatal Intensive Care: A Quality Improvement Project

Anna Sala  1 , Valentina Pivetti  1 , Francesca Castoldi  1 , Francesca Viaroli  1 , Marco Chiera  2 , Gianluca Lista  1 , Francesco Cavigioli  1
Affiliations

Impact of an Evidence-Based Bundle on Catheter-Associated Sepsis Incidence in Neonatal Intensive Care: A Quality Improvement Project

Anna Sala et al. Diseases. .

Abstract

Background: Central line-associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) pose a significant risk, especially for very low birth weight infants due to their immature immune systems and the need for invasive procedures. The implementation of evidence-based bundles, as recommended by international guidelines, has proven effective in significantly reducing CLABSI rates, improving clinical outcomes, and lowering hospital costs. However, evidence from long-term, real-world quality-improvement programs in European NICUs-especially those using repeated PDSA cycles and detailed monitoring across multiple periods-remains limited. Methods: This quality improvement prospective study, conducted in the NICU of "V. Buzzi" Children's Hospital, aimed to reduce high CLABSI rates using a plan-do-study-act (PDSA) framework. A multidisciplinary team developed and implemented a new evidence-based central line bundle in 2021, focusing on standardized practices, enhanced training, and monitoring. The study analyzed 594 CVCs placed in 348 neonates across a total 4-years period (P1-P12). Results: Implementation of a central line bundle significantly reduced CLABSI rates from 29.1 to 2.2 per 1000 CVC days (p-value 0.002), with notable variations during intermediate periods. Birth weight and study period progression were the only variables significantly associated with CLABSI reduction. Conclusions: Infection rates dropped significantly post-intervention, achieving zero in one of the latest periods: continuous monitoring, staff training, and targeted interventions were pivotal. Future efforts will focus on refining practices, increasing tunneled centrally inserted central catheter (CICC) use, and sustaining prevention measures.

Keywords: CLABSI; CVC; CoNS; NICU; bundle; infants.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Description of study periods.
Figure 2
Figure 2
Trend of CLABSI rate (number of infections/1000 CVC days) across study periods, including timing of intervention and data feedback sessions (staff meeting). The dashed line represents the regression line illustrating the overall decreasing trend in CLABSI rates across the study period.
Figure 3
Figure 3
Trend of CLABSI rate (number of infections/1000 CVC days) across study periods, stratified by neonatal population with between <1500 g and >1500 g.
Figure 4
Figure 4
Distribution of total central venous catheter (CVC) days by catheter type across study periods (P1–P12).
See this image and copyright information in PMC

References

    1. Polin R.A., Denson S., Brady M.T., Committee on Fetus and Newborn. Committee on Infectious Diseases. Papile L.-A., Baley J.E., Carlo W.A., Cummings J.J., Kumar P., et al. Epidemiology and Diagnosis of Health Care-Associated Infections in the NICU. Pediatrics. 2012;129:e1104–e1109. doi: 10.1542/peds.2012-0147. - DOI - PubMed
    1. Payne N.R., Carpenter J.H., Badger G.J., Horbar J.D., Rogowski J. Marginal Increase in Cost and Excess Length of Stay Associated with Nosocomial Bloodstream Infections in Surviving Very Low Birth Weight Infants. Pediatrics. 2004;114:348–355. doi: 10.1542/peds.114.2.348. - DOI - PubMed
    1. De Cicco M., Campisi C., Matovic M. Central Venous Catheter-Related Bloodstream Infections: Pathogenesis Factors, New Perspectives in Prevention and Early Diagnosis. J. Vasc. Access. 2003;4:83–91. doi: 10.1177/112972980300400302. - DOI - PubMed
    1. Zipursky A.R., Yoon E.W., Emberley J., Bertelle V., Kanungo J., Lee S.K., Shah P.S., Canadian Neonatal Network Investigators Central Line-Associated Blood Stream Infections and Non-Central Line-Associated Blood Stream Infections Surveillance in Canadian Tertiary Care Neonatal Intensive Care Units. J. Pediatr. 2019;208:176–182.e6. doi: 10.1016/j.jpeds.2018.12.011. - DOI - PubMed
    1. Rupp M.E., Karnatak R. Intravascular Catheter-Related Bloodstream Infections. Infect. Dis. Clin. 2018;32:765–787. doi: 10.1016/j.idc.2018.06.002. - DOI - PubMed

LinkOut - more resources