Reducing Catheter Associated Bloodstream Infections in the NICU: Challenging Nurses to Be Champions

Purpose for the program: Central Line Associated Bloodstream Infections (CLABSIs) are associated with increased mortality and adverse outcomes in multiple systems in the Neonatal Intensive Care Unit (NICU) patient. All of the literature in the last 2 years regarding CLABSIs has shown that with the implementation of evidence-based strategies, CLABSIs can be significantly reduced and in some cases completely eliminated. In June 2009, a designated committee at St Joseph’s Womens Hospital NICU began reviewing central line care and the current literature concerning best practices for central line management.

Proposed change: A comprehensive program was then developed. A timeline was established to implement multiple interventions into the unit’s guidelines for the management of central lines.

Implementation, outcomes and evaluation: Strategies included: (1) hand hygiene, (2) development and implementation of central line insertion and maintenance bundles, (3) validation for a team of nurses to perform peripherally inserted central catheter (PICC) insertion and dressing changes, (3) competency validation for all staff performing central line blood sampling, (4) standardized central line tubing change policy, (5) daily audits of all central lines for integrity and necessity, (6) “Scrub the hub” care, (7) Random Audits, and 8) development of a standardized sterilized PICC dressing change kit. CLABSI rates in the NICU decreased progressively from 10.17 per 1000 catheter days just before the initiative begun in June 2009 to 5.84 per 1000 catheter days by the end of the year. CLABSI rate for 2010 was 3.37 per 1000 catheter days. The number of bloodstream infections dropped from 30 in 2009 to 10 in 2010, a 67% decline. Conclusion: A comprehensive program of central line management led by a quality champion is effective in significantly reducing central line related bloodstream infections in the NICU.

Implications for nursing practice: Vital to the success of this program is the designation of a quality champion who is responsible for the initiative. This role includes: overseeing and participating in staff education, motivating and communicating with the team, random audits, and gathering surveillance data for quality improvement.

Keywords: central line associated blood stream infections, quality champion, central line bundle, hand hygiene, random audit, Neonatal Intensive Care Unit