Goodbye to BSI

Purpose:
The purpose of the project was to utilize best practices and evidence based processes to reduce BSI in a level 3 NICU. Research has shown that the adult population was able to nearly eliminate BSI. The project was open to all disciplines working with the NICU.

Significance:
Prevention of hospital acquired infection is an organizational and national goal. It is estimated that each neonatal bloodstream infection costs about $35,000 and adds about 2 weeks to a baby's length of stay. Premature infants are more susceptible to bloodstream infections.

Strategy and Implementation:
A multidisciplinary team lead by the Nurse Manager came together to research best practices in preventing BSI in NICUs. The team did a gap analysis of the best practices and our current practices. Action plans were created to implement best practices in our NICU and identify and develop solutions to any barriers to implementation. Listed below are the action steps implemented: *Development of a dedicated line insertion team *Utilization of a dedicated cart with supplies for line insertion *Implementation of best practices for line insertion and maintenance *Check sheets used to monitor compliance with best practice in each step of the process *Team joined a national 9 state collaboration to reduce BSI in NICUs with support from AHRQ. *Nurses and staff were empowered to call a "stop" in the process when check list items were not followed *Team focus was not punitive but to identify problems with process, education or supplies *Physician and nursing leadership was critical.

Evaluation:
Average BSI per 1000 line days:Jul-10 thru Nov-11 4.08, Dec-11 thru Nov-12 3.77, Dec-12 thru Feb-13 3.68. Maintained 100% compliance with insertion bundle since 2-12 and 100% compliance with maintenance since 1-12. Line utilization rates moved from .29 to .19 to .16 for measurement periods.

Implications for Practice:
BSI can be reduced in a NICU! Teamwork, tools, and consistent implementation of evidence based practices are the key. It is a continuous process improvement journey as team members become engaged and present opportunities for improvement.