Alcohol-impregnated port protectors to reduce central line-associated bloodstream infection in the neonatal intensive care unit: a quality improvement study.

Abstract

Objective: To investigate the effect of alcohol-impregnated port protectors (AIPPs) on neonatal central line-associated bloodstream infection (CLABSI) rates.

Design: A quality improvement study.

Setting: A tertiary neonatal unit in the UK.

Patients: Babies >72 hours of age with a central line.

Intervention: AIPPs were applied to intravascular access ports not allocated for fluid infusion from March 2018 to February 2020. Daily audits were performed for 3 months postimplementation, with quarterly audits thereafter.

Main outcome measures: CLABSI rates were calculated preimplementation and postimplementation with a 3-month washout period (March-May 2018). Logistic regression was used to analyse the risk of CLABSIs between periods, adjusting for important differences between cohorts.

Results: There was no difference in overall CLABSI rates per 1000 central lines days between the preimplementation and postimplementation periods (5.5 vs 6.6, p=0.5). However, rates of CLABSI involving confirmed pathogens rather than coagulase-negative Staphylococcus (CoNS) were higher postimplementation (0.5 vs 2.7, p=0.012). After adjusting for birth weight, gestational age at birth, gender, central line duration and length of stay, there were no significant differences in the overall risk of CLABSI between the two periods (OR 1.05, 95% CI 0.57 to 1.91, p=0.886) or the risk of CLABSI involving pathogens (OR 3.54 95% CI 0.77 to 16.06, p=0.102) or CoNS (OR 0.76 95% CI 0.39 to 1.46, p=0.406).

Conclusions: AIPPs did not result in reduced CLABSI rates. The use of AIPPs cannot currently be recommended.