Eliminating Neonatal CLABSI: The Yellow Brick Road to "ZERO"

Purpose:
Central venous catheters or peripherally inserted central catheters (PICCs), indispensable in neonatal care, are inserted for nutritional support and administration of parenteral medications. A major dilemma in neonatal care is preventing central line-associated blood stream infections (CLABSI).

Relevance/Significance:
CLABSIs, the most common hospital acquired infection (HAI) in the Neonatal Intensive Care Unit (NICU) cause substantial mortality and morbidity. Hospitalized neonates, who may have multiple invasive procedures, exposure to antimicrobial agents, and indwelling medical devices coupled with their innate vulnerabilities, such as immature skin and immune systems, predispose them to infection even without the added risks related to day-to-day care in the NICU.

Strategy and Implementation:
In May, 2010, The Pediatrix Medical Group 100,000 Babies Campaign was brought to our hospital by the medical staff. In order to address CLABSIs, a team of 12 nurses was chosen who, under the tutelage of the medical staff, undertook ownership of the PICC line insertion and maintenance process, including central line insertion and maintenance bundles as well as daily assessment of catheter needs in these highly vulnerable patients. The Plan-Do-Study-Act Methodology was the framework for the process change. The interprofessional collaboration between the PICC Line Team, the medical staff, and the nursing staff has resulted in the last CLABSI documented in October of 2011. The continued emphasis on the way in which each individual pays attention to and performs his/her job plus the way all individuals interrelate, interact, and communicate while working, ultimately determines the sustainability of high quality, safe health care and promotes an exemplary work environment.

Evaluation:
In 2009, the overall CLABSI rate was 4.2 and in 2010, the overall CLABSI rate was 2.4. There were only 2 CLABSIs in the year 2011, one in June, 2011 and the last one in October, 2011. Averaging approximately 100 line days per month since December of 2011, there have been no CLABSIs in the NICU, leaving a CLABSI rate of 0.00, consistently above the NDNQI performance goal.

Implications for Practice:
Celebrating 1200 days CLABSI free has been a milestone few NICUs have reached. Our NICU PICC Line Team, nursing staff, and medical staff have been stellar role models for improving patient outcomes, reducing error, and enhancing efficiency and cost reduction in delivering patient care.