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The Neonatal Intensive Care Unit at Yale New Haven Children’s Hospital recently marked one year without a central line-associated bloodstream infection. Among those attending a celebration were members of the PICC team, including (l-r): Christine Fontana, APRN; Orly Levit, MD; Deborah Moore, RN; Matthew Bizzarro, MD; Betty Edwards, RN; Gabrielle Perrault, RN; and Amy Fox, RN.


When Yale New Haven rolled out its high reliability organization effort in 2014, hospital leaders chose "getting to zero" as the theme.

Getting to zero events of harm is an ambitious goal, yet physicians and staff on the Neonatal Intensive Care Unit (NNICU) at Yale New Haven Children's Hospital recently achieved it, going over a year without a central line-associated bloodstream infection (CLABSI) in their patients.

"This is a momentous occasion," Matthew Bizzarro, MD, medical director, NNICU, said at a March 16 celebration. "By substantially reducing CLABSIs, this team has prevented significant complications for our most fragile patients and helped save lives."

The success of the unit's CLABSI-prevention efforts is particularly noteworthy since nearly 40 percent of all NNICU patients need at least one central line during hospitalization, and many require multiple lines, Dr. Bizzarro said. In the past year, more than 500 central lines were placed in the NNICU, which amounted to more than 4,500 central line days. While the primary concern with CLABSIs is patient harm, they also increase patients' length of stay and care costs.

Preparations for the CLABSI-prevention project started in 2005, when an NNICU team began analyzing situations in which infections occurred. They discovered that most were caused by bacteria that contaminate central lines – catheters inserted in patients' veins or arteries. The team studied national and international research on placing and maintaining central lines, and developed best practices for hand hygiene and central line care. They officially launched the CLABSI-prevention project in 2007.

To ensure clinicians consistently follow best practices, the NNICU created an education program and established the PICC (peripherally inserted central catheter) team, nurses whose main responsibilities are inserting central lines and ensuring they are properly maintained. The team has been key to the CLABSI prevention project's success, Dr. Bizzarro said.

"These results would not have been possible without nurses, physicians and staff members in many different roles working together," he said.