Beyond the Bundle: Preventing Central Line Associated Blood Stream Infections

Purpose:
Baby Isaiah, born at 26 weeks gestation, was entrusted to the care of Tri-City's NICU team on August 20, 2010. Three days later he was diagnosed with a central line infection, likely due to imperfect care. We knew we had failed him. Even a single infection affecting one baby was unacceptable.

Significance:
According to the US CDC, between 12-25% of patients who acquire CLABSI die, many others have extended hospital stays, and increased overall treatment costs. Our NICU is showing a decrease in the length of stay for our patients with central lines and our mortality rate is zero for 2011- March 2013.

Strategy and Implementation:
Nursing staff joined forces with Infection Prevention specialists, physicians, and management to take action. Our plan to eliminate future infections included reviewing current practice, re-educating staff, revamping policies and procedures, integrating the CLABSI bundle with renewed vigor, and researching best practices from other institutions. Within a few months, we had a strong commitment and plan. What makes us different from other institutions is that we've gone "Beyond the Bundle" and have implemented innovative ideas like laminated bedside placards that prominently distinguish babies with PICCs for all staff and ancillary personnel to see. We've included consulting physicians, personnel from ancillary departments and families in our education of hand hygiene, infection control practices and line management. We recognize that sustained vigilance is necessary to keep this Zero CLABSI trend going!

Evaluation:
Implementation of our Zero CLABSI plan has been successful. We have not had another CLABSI since Isaiah's…986 days and counting!Our NICU team has achieved 100% Central Line Bundle Compliance for the past year.

Implications for Practice:
Going "Beyond the Bundle" equates to high quality cost effective care. The estimated cost of a blood stream infection in children ranges from $36,000-$50,000. On average avoiding one CLABSI case per year translates into a $43,000 positive financial impact.