A Culture of Safety in the Neonatal ICU

Purpose:
Defining infection in the Neonatal intensive care unit at Sparrow hospital required staff to develop the understanding that infections were preventable in this very frail and tiniest of patients. "Not on my watch" would become the mantra and settle into our culture for the safety of our babies.

Significance:
When born early, the preterm infant must overcome tremendous obstacles in the maturation process. Body systems must regulate and mature. Development progresses with each passing week. The risk of acquiring a central line associated blood stream infection (CLABSI)is substantial.

Strategy and Implementation:
The road to our culture change began with determining where we were as a unit. This involved surveying every member of our team which includes, Neonatologist, Fellows, Nurse practitioners, Physician assistance, Nurses, Respiratory Therapist, Phlebotomist, clinical dietician, clinical pharmacist, radiology and infant massage volunteers. Determining where we were, helped us to set our course to improvement. Staff nurses were engaged and participated in development of a central line bundle and process change. Meeting with our physician champion frequently to implement each piece of the CLABSI bundle, staff nurses began to help change the culture. Parents were engaged through use of glow germ and seeing first hand the importance of hand hygiene for both themselves and their visitors to the infants bedside. A thread that began to weave itself throughout the unit was that of protection and ability of any team member to confront any individual if it was suspected they had not washed.

Evaluation:
We successfully completed 257 days without a CLABSI. A celebration for all staff including our CEO, CNO complete with cake! Staff celebrated knowing we had reduced mortality and morbidity within our given patient population.

Implications for Practice:
There are many pieces to our central line bundle. Each part plays an important role in the sum. IV fluids, TNP, IL hung with sterile set-up. Central line dressings, changed once a week. Instituted CHG. A culture of acceptance to approach individuals and ask if they have cleaned their hands.