Reducing Catheter Associated Bloodstream Infections in the Neonatal Intensive Care Unit: Challenging Nurses to Be Champions
Article first published online: 14 JUN 2012
© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Special Issue: 2012 Convention Proceedings
Volume 41, Issue s1, page S48, June 2012
How to Cite
Solomon, J. (2012), Reducing Catheter Associated Bloodstream Infections in the Neonatal Intensive Care Unit: Challenging Nurses to Be Champions. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41: S48. doi: 10.1111/j.1552-6909.2012.01360_30.x
- Issue published online: 14 JUN 2012
- Article first published online: 14 JUN 2012
- central line associated blood stream infections;
- quality champion;
- central line bundle;
- hand hygiene;
- random audit;
- neonatal intensive care unit
Purpose for the Program
Central line-associated bloodstream infections (CLABSI) are associated with increased mortality and adverse outcomes in multiple systems in the neonatal intensive care unit (NICU) patient. All of the literature in the past 2 years regarding CLABSI has shown that with the implementation of evidence-based strategies, CLABSI can be significantly reduced and in some cases completely eliminated. In June 2009, a designated committee at St. Joseph's Women's Hospital's NICU began reviewing central line care and the current literature concerning best practices for central line management.
A comprehensive program was developed, and a timeline was established to implement multiple interventions into the unit's guidelines for the management of central lines.
Implementation, Outcomes, and Evaluation
Strategies included the following: (a) hand hygiene, (b) development and implementation of central line insertion and maintenance bundles, (c) validation for a team of nurses to perform peripherally inserted central catheter (PICC) insertion and dressing changes, (d) competency validation for all staff performing central line blood sampling, (e) standardized central line tubing change policy, (f) daily audits of all central lines for integrity and necessity, (g) “scrub the hub” care, (h) random audits, and (i) development of a standardized sterilized PICC dressing change kit. CLABSI rates in the NICU decreased progressively from 10.17 per 1,000-catheter days just before the initiative begun in June 2009 to 5.84 per 1,000-catheter days by the end of the year. The CLABSI rate for 2010 was 3.37 per 1000-catheter days. The number of bloodstream infections decreased from 30 in 2009 to 10 in 2010, a 67% decline.
Implications for Nursing Practice
A comprehensive program of central line management, led by a quality champion, is effective in significantly reducing CLABSI in the NICU. The designation of a quality champion who is responsible for the initiative is vital to the success of this program. This role includes overseeing and participating in staff education, motivating and communicating with the team, random audits, and gathering surveillance data for quality improvement.