Objective To evaluate if a closed-medication delivery system (CMDS) is effective in reducing the rate of central line-associated bloodstream infection (CLABSI) in very low birth weight (VLBW) infants. CLABSI is a common problem in the neonatal intensive care unit (NICU). Rates of CLABSI are highest among VLBW infants (birth weight ⩽1500 g) requiring central lines for prolonged total parenteral nutrition.
Methods In 2004, a performance improvement team focused on reducing the incidence of nosocomial infection in the NICU. Infection control measures, such as hand hygience compliance, sterile central line insertion and central line tubing care practices were standardised and monitored regularly. In 2006, the use of a CMDS was adopted. The incidence of CLABSI in VLBW infants 18 months before and after the adoption of CMDS was compared. The CLABSI rate was calculated using the National Healthcare System Network method of reporting (# CLABSI ÷ central line days × 1000).
Results Baseline CLABSI before CMDS was 3.39/1000. Central line days was not different before and after intervention, 10 019 versus 10 977. Use of CMDS was associated with 59% reduction in total number of CLABSI (34 cases pre-CDMS down to 14 cases post-CMDS) and a decline in infection rate to 1.28 per 1000 (see fig).
Conclusion The use of a closed system in delivering medications is associated with a decreased incidence of CLABSI in VLBW infants.