Implementation of a multicomponent neonatal vascular-access care bundle for central line-associated bloodstream infection prevention: A before-and-after quality improvement study

This before-and-after quality improvement study evaluated a multicomponent neonatal vascular-access care bundle incorporating workflow redesign principles for peripherally inserted central catheters (PICC) and umbilical venous catheters (UVC) in a single Level III NICU in China. Neonates requiring PICC or UVC were consecutively enrolled from January 2024 to January 2026. The bundle included bedside-accessible hand hygiene, a standardized 15-s scrub/15-s dry protocol, a dedicated vascular access team, and daily multidisciplinary line audits. Bundle compliance increased significantly from 60.2% to 90.6% after implementation (GEE, p = 0.0003). CLABSI rates were numerically lower after implementation, decreasing from 6.75 to 3.43 per 1000 catheter-days for PICC (IRR 0.51; 95% CI 0.13–1.93; p = 0.252) and from 10.60 to 4.24 per 1000 catheter-days for UVC (IRR 0.40; 95% CI 0.04–3.84; p = 0.406). These reductions did not reach statistical significance, and the wide confidence intervals indicate limited statistical power. A CDC/NHSN-only sensitivity analysis yielded the same case counts and incidence rates as the primary analysis. Median hospital stay among neonates with UVC was shorter after implementation, declining from 42.0 to 29.0 days ( p = 0.011), although this finding should be interpreted cautiously in this before-and-after study. Mechanical complications showed descriptive downward trends. The multicomponent care bundle was associated with significantly improved procedural compliance. CLABSI rates were numerically lower but did not reach statistical significance. The single-center design in China and the small number of CLABSI events limit precision and generalizability. Larger multicenter studies using standardized surveillance definitions are needed to confirm effects on CLABSI and broader neonatal vascular-access outcomes.