Priceless Improvements In the Reduction of Catheter Associated Blood Stream Infection In the Neonatal Intensive Care Unit at Jeff Gordon Children's Hospital
Audio File
- Identify simple changes in insertion techniques for central line catheters.
- Examine individual NICU practice that could potentially increase compliance with evidence based best practices.
- Correlate process changes with positive outcomes for neonates in the NICU.
Healthcare providers and administration from the Neonatal Intensive Care Unit at Jeff Gordon Children’s Hospital, Carolinas Medical Center NorthEast chose to participate in the Perinatal Quality Collaborative of North Carolina (PQCNC) Catheter Associated Blood Stream Initiative (CABSI) for 2009 – 2010. This initiative was believed to have the potential to impact outcomes at every facility and improve the outcomes for a large population of North Carolina patients. CMC NorthEast has joined the PQCNC in a collaborative effort to reduce the BSI rate in our NICU. |
Proposed change:
The goal of this PQCNC initiative was to reduce CABSI by 75% in participating Newborn Critical Care Centers (NCCC) by standardizing central line insertions and their maintenance. The goal at CMC NorthEast has been much more aggressive. On September 3, 2009, a multidisciplinary team at our facility collaborated and proposed a target BSI rate of 1.6 with a stretch goal of “0” by April 1st, 2010.
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Implementation, outcomes and evaluation:
- NICU BSI Rates
- Necessity of PICC/central line addressed by MD daily
- Procedural checklist initiation
- Procedural checklist completion
- Daily line maintenance log - specifically using CHG for skin & port cleansing.
- NICU hand hygiene stretch goal of 95%
Implications for nursing practice:
Our NICU infection control CABSI rates per 1000 device days in the past years were 3.7% in 2006, 4.3% in 2007, and 1.5% in 2008. Our rate for all of 2009 was “0.” Year to date 2010 is “0”. As of September 7th, 2010 it has been 682 days since the last CABSI in our NICU.
We have had a culture change in our NICU in regards to the insertion and maintenance of our central lines and peripheral IVs. Hand hygiene improvements have been incorporated into our daily routines by families and health care providers who have embraced it as one simple safety factor in their control. We continue to encourage all of our health care providers and parents to adopt and maintain the standards of care that have allowed our unit to successfully protect our tiny priceless patients.
Keywords: NICU, CABSI, CHG, Central Lines
