Implementation of a shared decision making model in NICU to achieve zero healthcare associated blood stream infections

Purpose:
To implement a shared decision-making process using evidence-based practice to achieve the hospital target of “Always Zero” healthcare associated blood stream infections (HCABSI), to reduce length of stay and to reduce healthcare costs in a busy NICU.

Significance:
The literature supports increased newborn mortality with blood stream infection (HCABSI). A program to reduce HCABSI improves long term patient outcomes, decreases length of stay and reduces total health care costs.

Strategy and Implementation:
A multidisciplinary team including nursing, physicians, respiratory therapy, and infection control established a task force to review clinical practice, root causes and prevention of healthcare associated blood stream infections. Based on a literature review, the team identified potential sources of infection including patient equipment, environment, hand hygiene and education. The findings were shared with the multidisciplinary team through journal clubs and team meetings. The team collaborated with staff to prioritize strategies to reduce blood stream infections. Strategies included the development of a skin care protocol emphasizing the reduction of skin punctures, nutrition education, and increased hand hygiene monitoring. Equipment strategies included improved hub cleaning, in line blood drawing, and central line care with implementation of a central line bundle, and PICC line insertion. General cleanliness of the individual bedspace for the baby was also improved.

Evaluation:
The HCABSI rate was 21% at baseline and 17% at year 1. There were no HCABSI for all infants, including with central lines, for the last 13 months. Length of stay was reduced by 4 days for each infant with a HCABSI resulting in potential savings of $35,000 per year.

Implications for Practice:
Shared decision-making helps the multidisciplinary care team identify safe patient care practices. The implementation of evidence based care determined collaboratively improves safe patient care, reduces complications and decreases costs as we achieve our “Always Zero” goal.