How to minimize central line–associated bloodstream infections in a neonatal intensive care unit: a quality improvement intervention based on a retrospective analysis and the adoption of an evidence-based bundle

2020 ◽  
Author(s):  
Stéphanie Bierlaire ◽  
Olivier Danhaive ◽  
Katherine Carkeek ◽  
Fiammetta Piersigilli
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Quality Improvement Intervention ◽  
Evidence Based ◽  
Improvement Intervention

scholarly journals Quality Improvement Measures to Reduce Central-Line–Associated Bloodstream Infections (CLABSIs) in a Neonatal Intensive Care Unit (NICU)

2020 ◽  
Vol 41 (S1) ◽  
pp. s362-s363
Author(s):  
Tamika Anderson ◽  
Michelle Flood ◽  
Susan Kelley ◽  
Lea Ann Pugh ◽  
Renato Casabar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Multidisciplinary Team ◽  
Neonatal Intensive Care ◽  
Infection Prevention ◽  
Bloodstream Infections ◽  
Neonatal Infection ◽  
Central Line ◽  
Evidence Based

Background: Central-line–associated bloodstream infections (CLABSIs) are a significant contributor to morbidity and mortality for neonates; they also increased healthcare costs and duration of hospitalization. This population is susceptible to infections because of their undeveloped immune systems, and they require intravenous access until they can tolerate enteral feedings, which for extremely premature infants can take several weeks (if not months) to achieve. Our hospital is a regional-referral teaching hospital with 772 licensed beds. The neonatal intensive care unit (NICU) is a level 3, 35-bed unit where the most critically ill neonates receive care. After a sustained 3-year period of zero CLABSIs, we identified 10 infections between September 2016 through April 2018. Methods: A multidisciplinary team known as the neonatal infection prevention team (NIPT) was reinstated. This team included members from nursing and infection prevention (IP) and from NICU Shared Governance, as well as a neonatal nurse practitioner (NNP) and a neonatologist to review these CLABSIs. Evidence-based practices, policies, and procedures were implemented to help reduce CLABSIs. Nurse educators provided education and training. The infection prevention team reinstated and modified the central-line maintenance and insertion tools to document compliance and to identify any gaps in care. Nurses were expected to document line maintenance once per shift (a.m. and p.m.). All CLABSIs were entered into the CDC NHSN and the hospital’s safety event reporting system, which required follow-up by a clinical manager. The infection prevention team monitored NHSN standardized infection ratios (SIRs) monthly. The SIR is the number of observed events divided by the number predicted (calculated based on national aggregate data). Results: The highest reported quarterly SIR was 1.423, which occurred in the third quarter of 2018 (Fig. 1). Overall compliance with line maintenance protocols was 86% on the morning shift and 89% on the afternoon shift. With implementation of an evidence-based bundle, the NICU had a rolling 12-month SIR of 0.00 as of October 2019. Conclusions: Multidisciplinary team development, implementation of evidence-based bundle elements, and education on catheter care contributed to the long-term success in decreasing CLABSI rates in our NICU. Although this implementation achieved a zero CLABSI rate, we experienced some barriers, including compliance issues with staff not completing the audit tools, staff turnover, and high patient census.Funding: NoneDisclosures: None

scholarly journals Chlorhexidine Bathing in a Tertiary Care Neonatal Intensive Care Unit: Impact on Central Line–Associated Bloodstream Infections

2014 ◽  
Vol 35 (2) ◽  
pp. 158-163 ◽  
Author(s):  
Caroline Quach ◽  
Aaron M. Milstone ◽  
Chantal Perpête ◽  
Mario Bonenfant ◽  
Dorothy L. Moore ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Adverse Events ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
The Impact

Background.Despite implementation of recommended best practices, our central line-associated bloodstream infection (CLABSI) rates remained high. Our objective was to describe the impact of chlorhexidine gluconate (CHG) bathing on CLABSI rates in neonates.Methods.Infants with a central venous catheter (CVC) admitted to the neonatal intensive care unit from April 2009 to March 2013 were included. Neonates with a birth weight of 1,000 g or less, aged less than 28 days, and those with a birth weight greater than 1,000 g were bathed with mild soap until March 31, 2012 (baseline), and with a 2% CHG-impregnated cloth starting on April 1, 2012 (intervention). Infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with mild soap during the entire period. Neonatal intensive care unit nurses reported adverse events. Adjusted incidence rate ratios (aIRRs), using Poisson regression, were calculated to compare CLABSIs/1,000 CVC-days during the baseline and intervention periods.Results.Overall, 790 neonates with CVCs were included in the study. CLABSI rates decreased during the intervention period for CHG-bathed neonates (6.00 vs 1.92/1,000 CVC-days; aIRR, 0.33 [95% confidence interval (CI), 0.15-0.73]) but remained unchanged for neonates with a birth rate of 1,000 g or less and aged less than 28 days who were not eligible for CHG bathing (8.57 vs 8.62/1,000 CVC-days; aIRR, 0.86 [95% CI, 0.17-4.44]). Overall, 195 infants with a birth weight greater than 1,000 g and 24 infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with CHG. There was no reported adverse event.Conclusions.We observed a decrease in CLABSI rates in CHG-bathed neonates in the absence of observed adverse events. CHG bathing should be considered if CLABSI rates remain high, despite the implementation of other recommended measures.

Device-Associated Infections (Outside of the Neonatal Intensive Care Unit)

2019 ◽  
pp. 31-58
Author(s):  
Manjiree V. Karandikar ◽  
Grace M. Lee ◽  
Galit Holzmann-Pazgal ◽  
Susan Coffin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Pediatric Care ◽  
Patient Specific ◽  
Prevention Strategies ◽  
Tract Infections

Device-associated infections cause substantial morbidity in children. These healthcare-associated infections (HAI) can increase length of stay and healthcare costs. The strategies used to prevent device-associated infections in children can vary, depending on many patient-specific factors, including the child’s age and physical location when receiving inpatient pediatric care. In addition, infection prevention strategies in children are not always the same as adult prevention strategies. This chapter reviews practical, evidence-based strategies to prevent pediatric ventilator-associated events (VAE), central line–associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI). The recommendations focus on patients outside the neonatal intensive care unit (NICU) setting.

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