Pillai A, Kabra N, Nayak A, Bhanushali M, Balasubramanian H, Shivananda S. Transforming central line associated blood stream infection prevention in neonates: Results from a multimodal quality improvement initiative. World J Clin Pediatr 2026; 15(3): 118413 [DOI: 10.5409/wjcp.118413]
Corresponding Author of This Article
Nandkishor Kabra, Head, Professor, Department of Neonatology, Surya Hospitals, Mangal Ashirvad, S.V Road, Santacruz West, Mumbai 400054, Mahārāshtra, India. drkabra@suryahospitals.com
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Pediatrics
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research-article
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Pillai A, Kabra N, Nayak A, Bhanushali M, Balasubramanian H, Shivananda S. Transforming central line associated blood stream infection prevention in neonates: Results from a multimodal quality improvement initiative. World J Clin Pediatr 2026; 15(3): 118413 [DOI: 10.5409/wjcp.118413]
Anish Pillai, Department of Neonatology and Pediatrics, Motherhood Hospital, Navi Mumbai 410210, Mahārāshtra, India
Nandkishor Kabra, Anuja Nayak, Mayuri Bhanushali, Haribalakrishna Balasubramanian, Department of Neonatology, Surya Hospitals, Mumbai 400054, Mahārāshtra, India
Sandesh Shivananda, Division of Neonatology, British Columbia Women’s Hospital and Heath Centre, Vancouver V6H 3N1, British Columbia, Canada
Author contributions: Pillai A and Kabra N conceptualized the work, supervised the work and made critical revisions; Nayak A, Bhanushali M, and Balasubramanian H performed the literature review and prepared the initial manuscript draft; Pillai A and Shivananda S edited the figures and prepared the discussion; Kabra N, Balasubramanian H, and Shivananda S analysed and summarized the data; and all authors reviewed the manuscript and approved the submitted version.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Surya Children’s Medicare, approval No. EC-05/12/2020.
Clinical trial registration statement: Not applicable as this is a quality improvement project.
Informed consent statement: The informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: Not applicable as this is a quality improvement project. SQUIRE guidelines have been followed for this quality improvement project.
Data sharing statement: The datasets generated or analyzed during the current study are not publicly available due to institutional policy. However, de-identified data can be shared at-request by the corresponding author.
Corresponding author: Nandkishor Kabra, Head, Professor, Department of Neonatology, Surya Hospitals, Mangal Ashirvad, S.V Road, Santacruz West, Mumbai 400054, Mahārāshtra, India. drkabra@suryahospitals.com
Received: January 15, 2026 Revised: February 21, 2026 Accepted: April 8, 2026 Published online: September 9, 2026 Processing time: 210 Days and 8.5 Hours
Abstract
BACKGROUND
Central line-associated bloodstream infections (CLABSI) are a major cause of morbidity and mortality among neonates in intensive care units. Quality improvement (QI) initiatives targeting CLABSI prevention can significantly enhance patient outcomes.
AIM
To evaluate the impact of a multimodal QI initiative on reducing CLABSI incidence in a level-3 neonatal intensive care unit (NICU) and sustaining the improvement over time. The goal was to achieve a 50% reduction in CLABSI rates within 12 months and maintain results for an additional 18 months.
METHODS
This prospective interventional study was conducted in a level-3 teaching NICU in Western India. All neonates with central venous access during NICU stay were included. Baseline CLABSI rates were measured over a pre-intervention period. The intervention bundle comprised strengthening hand hygiene practices, customizing and updating CLABSI prevention bundles, revising environmental cleaning protocols, conducting regular audits of line insertion and maintenance practices, and implementing structured nursing education sessions. Multiple Plan-Do-Study-Act cycles were used to refine interventions and monitor compliance.
RESULTS
The baseline CLABSI rate was 6.4 per 1000 central line days, which decreased to 1.1 per 1000 central line days post-intervention; an 83% reduction. During the 18-month sustainability phase, rates remained low at 0.96 per 1000 central line days. Hand hygiene compliance, adherence to central line bundles, and nursing education coverage improved significantly throughout the intervention and maintenance phases.
CONCLUSION
Implementation of a structured, multimodal QI bundle emphasizing hand hygiene, tailored central line care bundles, regular audits, and nursing education resulted in a substantial and sustained reduction in CLABSI rates. This approach is feasible, cost-effective, and replicable in similar resource-constrained NICU settings.
Core Tip: A structured, multimodal quality improvement initiative led to a substantial and sustained reduction in neonatal central line associated blood stream infection rates in a level-3 neonatal intensive care unit. By strengthening hand hygiene, customizing central line care bundles, reinforcing environmental cleaning, conducting regular audits, and providing ongoing nursing education through iterative Plan-Do-Study-Act cycles, central line associated blood stream infection rates fell by over 80% and remained low for 18 months. This low-cost, pragmatic approach is feasible and reproducible in resource-constrained neonatal intensive care unit settings, including low- and middle-income countries.
