Impact of a Primary Neonatal Line Insertion Team on Catheter Related Bloodstream Infections

Purpose:
Our level III NICU experienced a trend of elevated infections. The majority of these infections were related to venous catheters. A primary line insertion team was developed to address this increase in infections in the NICU. The goal of this team was to directly impact catheter related infections.

Significance:
Vascular access is vital to the administration of intravenous medications and fluids. While important, vascular access is not a benign therapy with many becoming infected during use. Nosocomial infections are a significant contributor to the mortality and morbidity of hospitalized patients.

Strategy and Implementation:
A Master's program student presented the concept of a primary line insertion team. A significant factor in the development of a specialized team is the decreased exposure to the patients of multiple healthcare providers. Limiting the number of staff that insert lines also decreases the variations in how the lines are placed as well as consistency in management of the line. A line team consisting of two nurses, one with line placement experience was formed. A protocol was drafted based primarily on CDC recommendations and presented to the medical group for approval. The proposed changes included line team inserting majority of lines as well as changes in current procedure. Once the protocol was approved the PICC team was trained and staff educations completed. The PICC team monitors all lines on a daily basis to evaluate any identified infections regarding primary versus secondary infections and feeds this information back to the staff.

Evaluation:
The primary measure tracked were positive bloodstream infections. Infections were defined using the National Nosocomial Infections Surveillance System guidelines. By implementing a primary neonatal line insertion team we were able to achieve a 50% reduction in CRBSI.

Implications for Practice:
Implications for practice are a direct decrease in catheter related bloodstream infections. Changes that were put into place are numerous but those with the greatest impact are the line team, full barrier precautions, daily monitoring, PRN dressing changes and tracking infection free days.