ArticleBMJ open quality2026
From lines to lifelines: a quality improvement study to reduce CLABSI at a level III NICU in LMIC.
Article in BMJ open quality, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCentral line-associated bloodstream infection (CLABSI) is a major contributor to morbidity and mortality among neonates admitted to the neonatal intensive care unit (NICU). Point-of-care quality improvement (POCQI) methods can reduce the rate of CLABSI by improving compliance with the care bundle.
methodsA quality improvement study comprising three phases was planned in the NICU of a tertiary care hospital in western India to assess the impact of the central line care bundle. Baseline data were collected for 8 weeks to find the incidence of CLABSI. An aim statement was made and a team formed. A root cause analysis was conducted to identify the factors contributing to the high rate of CLABSI. Various changed ideas were tested in plan-do-study-act cycles and monitored with process indicators. Ideas were adopted or adapted based on their impact. Compliance with insertion and maintenance bundles was used as a process indicator, while the CLABSI rate served as an outcome indicator.
resultsCLABSI rate reduced from 66/1000 catheter days (May 2023) to 18/1000 catheter days (95% CI 0.14 to 0.79; p value 0.012) during the study. Insertion bundle compliance increased to 85% during the intervention phase and 70% during the sustainability phase. Maintenance bundle compliance was 45% and 35% during the intervention and sustainability phases, respectively.
conclusionPOCQI methods can help increase bundle care compliance in the NICU and reduce CLABSI rates in low- and middle-income country settings.
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