Reducing Central Line Infection Rate: Creating a Positive Patient Safety Culture in the NICU

Purpose:
Our NICU is dedicated to reducing central line associated blood stream infection (CLABSI) rates. The purpose is to highlight initiatives necessary to attain and sustain zero blood stream infections in the neonatal population using an interdisciplinary approach.

Relevance/Significance:
Neonates are among the most fragile and vulnerable patients. Central line blood stream infections in this patient population can lead to undesirable consequences such as exposure to antibiotic therapy and painful procedures, increased length of stay, and additional healthcare costs. Moreover the emotional implications and stress to the family compound an already difficult time. The effects of these negative outcomes can jeopardize institutional viability and are not congruent with our mission.

Strategy and Implementation:
Unit specific data was analyzed and we learned of our opportunity to eliminate CLABSI. The Neonatal Infection Prevention Team (NIPT) was created to evaluate evidence-based best practices related to prevention of CLABSI and coordinate a staff education plan, which included the Comprehensive Unit-Based Safety Program (CUSP), infection control guidelines, and expectation to complete daily central line maintenance audit and line tracking log. Developing effective communication amongst caregivers is essential for a functioning team. Infection rates were discussed in team safety huddles, interdisciplinary rounds and a root cause analysis was completed after every reported event and opportunities shared with staff. Catheter insertion and maintenance best practice changes were accepted, thus helping to create a positive patient safety culture in the NICU setting. Continual vigilance and surveillance has supported staff ownership and sustained the zero CLABSI rate.

Evaluation:
2008 NICU CLABSI rates averaged 3.13 per 1000 line days. By implementing education strategies there was a decrease in the rate of CLABSI, yet these results were not sustained. In 2012, the project initiatives shifted to one of supporting a culture of safety, thus resulting in rates decreasing from 2.54 per 1000 line days to zero in 2013. To date our NICU is more than 866 days without a CLABSI.

Implications for Practice:
Using an interdisciplinary team approach an opportunity was identified. A plan was created implemented. Using this strategy, outstanding results were achieved and maintained. It is proven that with the conscientious effort of the nursing team, CLABSI(s)can be reduced and eliminated.