Getting to Zero: Implementation of a Nurse Directed Neonatal Peripherally Inserted Central Catheter (PICC) Team

Purpose:
The PICC associated bloodstream infection rate for our unit was 11.8 per 1000 catheter days. By utilizing guidelines provided by the Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare Improvement (IHI), our unit established a nurse led neonatal PICC team.

Significance:
Central line associated bloodstream infection (CLABSI) is a frequent complication of vascular access devices, leading to increased length of stay, infant morbidity and mortality. The effectiveness of a nurse led team has demonstrated improved patient outcomes; notably, the decline of CLABSI.

Strategy and Implementation:
After a review of the literature and interdisciplinary collaboration, key variances were identified. First, an interview process and analysis of insertion statistics identified 7 nurses and 3 support nurses for the PICC Team, including a Neonatology liaison. Second, the team was responsible for staff education (role of the PICC Team and medical staff, care and maintenance of central lines).In addition, bilingual education tools were created for parent education. Third, was the standardization of the insertion and maintenance processes, leading to the creation of a PICC bundle (PICC candidate criteria, cart, insertion and dressing change process, split septum devices, chlorhexidine, and reference book). To improve communication, a board was used to identify candidates. Lastly, performance improvement tools captured compliance data and infections. Results were shared during nursing and medical leadership forums, staff and PICC meetings, and on unit and organization nursing dashboards.

Evaluation:
Monthly review of PICC data was reported by our Infection Preventionist nurse. Within 3 months, our PICC associated infection rate declined to zero. Our NICU has sustained zero PICC infections for 12 months. Overall, the rate has been reduced by greater than 90% (11.8 to 1.06 per 1000 PICC days).

Implications for Practice:
A dedicated team, a standard for insertion, care and maintenance and having staff and leadership educated and engaged, was and is crucial for sustainment. Knowledge and continual review of the evidence is also important, therefore, we participate in a nationwide initiative; On the CUSP: Stop BSI.