NICU 500-DAYS CLABSI-FREE

Infections in the bloodstream are a risk for critically ill infants and children with central intravenous lines for medications and nutrition. In order to reduce the risk of a Central Line Associated Bloodstream Infection (CLABSI) in our fragile NICU population, the NICU created a CLABSI reduction team and implemented many changes to protect our patients with a goal of zero over the course of a year. The NICU at Community Children’s has celebrated over 500 days with zero CLABSIs.

CLABSI is a significant contributor to morbidity and mortality for infants in NICUs because of these patients have immature immune systems.

Our CLABSI reduction team included neonatologists, a NNP, NICU clinical coordinator, NICU RNs, representatives from Infection Control and Pharmacy. Full collaboration would give the best rate of success. Research shows that there is not one specific change that can be made in order to reduce the risk of a CLABSI, but rather central line insertion and maintenance bundles are the best method for prevention.

  • We started with assessing our IV line supplies and changed products in order to reduce the number of connections, which in turn reduces the risk of infection.
  • Central line insertion bundles were revised for standardization and up to date practice.
  • 2-person sterile line changes were implemented.
  • A daily audit tool was created to assess the following:
    • Necessity of the line
    • Tubing assembled correctly and labeled for date change
    • Central line dressing intact and occlusive

In order to implement the changes in practice, all nurses attended a mandatory 4-hour skills day to review changes and have time to practice the 2-person sterile line change. Tools were made for nurses to reference including a video showing the line change procedure and laminated pictures of the lV line connections and set up. A new practice was developed to have a team convene and complete a chart review if an infant were to be diagnosed with CLABSI in order to identify potential contributors and improve practice.

We are taking this opportunity to recognize the ongoing efforts of our NICU team to sustain this achievement including NICU Clinical Coordinators, NICU RN’s, Neonatologist, Neonatal Practitioners, Respiratory Therapists and our Health Unit Coordinators. This quality improvement project emphasized the importance of multidisciplinary collaboration, the need to evaluate the evidence and implement best practice, and the value of employee engagement.

Stat: Average hospital cost for one CLABSI is $35,000.