Table 1

Table describing the three phases of the study

PhaseName of phaseDuration (weeks)Interventions during the phase
IBaseline phase12
  • Routine procedures of catheter care and maintenance were observed to gain understanding of the process flow

  • Baseline compliance to the central line insertion and maintenance checklists (process indicators) was not obtained as there was no routine policy of following central line insertion and maintenance bundle prior to this study

  • Baseline incidence data were collected for the outcome indicators

IIIntervention phase24
  • A QI team was formed comprising resident doctors, nursing supervisors, staff nurses, store in-charge nurse, multipurpose workers and mothers of admitted babies

  • Process flow chart and fish bone diagram were used to conduct a root cause analysis and identify factors contributing to LONS in the VLBW babies with central lines in the unit

  • Multiple change ideas were developed and tested using short sequential PDSA cycles to enable implementation of CLABSI bundle

  • Education sessions for the staff regarding rational use of central lines, proper insertion and maintenance techniques were undertaken

IIIPost-intervention/sustenance phase24
  • Low compliance to maintenance bundle was addressed by testing the idea of continuing education among staff and knowledge testing with periodically conducted tests (PDSA 10)

  • CLABSI, central line associated bloodstream infection; LONS, late-onset neonatal sepsis; PDSA, Plan-Do-Study-Act; QI, quality improvement; VLBW, very low birth weight.