Medical Student University of Illinois College of Medicine Lemont, Illinois, United States
Background: Premature neonates are at high risk of infection due to immature skin barriers and immune systems. These patients often require a high level of care supported by central lines. Placement, monitoring, and maintaining the environment of each central line is crucial to preventing life-threatening infections in the NICU. Objective: Our SMART AIM is to decrease CLABSI rates in the NICU from 2.07 per 1000 days to 1.5 per 1000 days by July 2024. Design/Methods: We engaged a multidisciplinary team involving neonatologists, APNs, NICU nurses, infection prevention specialists, and administrators in the Fall of 2022 who met monthly to discuss interventions for CLABSI prevention. Major interventions included: 1. Improving compliance with hand hygiene. 2. Improving cleanliness of the patient environment. 3. Initiation of UV sterilization. 4. Creation of a formal CLABSI bundle. 5. Institution of sterile tubing changes. 6. Optimizing documentation for cases of secondary bacteremia. Multiple PDSA cycles were performed for each major intervention. The main outcome measure was the rate of CLABSIs per 1000-line days as well as days between CLABSIs on the unit. Process measures included hand washing audits and environmental care tracer audits from the infection and prevention team. Balancing measures have included staff satisfaction. Results: The monthly CLABSI rate has remained stable throughout the time period. However, our unit was able to go 153 days without a CLABSI in 2023, demonstrating progress. Compliance with hand hygiene has improved over the last 5 months to 95% through effective interventions. Focused nursing education and audits to improve the cleanliness of the patient environment have improved over time.
Conclusion(s): A combination of the implemented strategies led to a 153 day CLABSI-free period along with an improvement in hand hygiene compliance in the unit and an increase in engagement of NICU staff in CLABSI prevention. Through the utilization of PDSA cycles the team has identified further areas of opportunity including the use of non-sterile gloves during care for patients with central lines and alternative products to decrease direct access of lines by nursing staff.
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