583. Improving Catheter Scrub Technique and Compliance in a Level IV Neonatal ICU

Abstract

BackgroundCentral line-associated bloodstream infections (CLABSIs) are challenging to prevent in the neonatal population due to the long-term necessity of central access for nutrition and medication. Neonates are a population at high risk for CLABSIs, and infections in this group are associated with prolonged hospitalization, greater healthcare costs, and increased mortality. Current bundles for CLABSI prevention include a friction scrub of the catheter hub prior to each use. Real-time audits of correct technique can be challenging. In July of 2018, our team developed a new strategy for auditing scrub technique in an attempt to reduce CLABSI rates.MethodsThis project took place in a NICU with 118 level 4 beds from July 2018 to February 2019. Our NICU is located in a large metropolitan area and serves as a referral center for complex neonates throughout the region. The intervention period encompassed 25,085 patient-days and 6,206 line days. Real-time friction scrub audits were performed for both dedicated line team staff as well as bedside nurses. In order to determine whether a healthcare worker’s (HCW) scrub technique was successful, a colorless luminescent product was applied to a practice catheter hub that adhered to the hub, but was not visible to the HCW. The HCW would then demonstrate a friction scrub on the practice catheter, and the hub was placed under a black light to show where any residual product may be present. This process was repeated until the staff member was able to remove the product from the hub. Once the staff was successful, monthly real-time audits were continued to reinforce the correct technique.ResultsBetween July 2018 and February 2019, compliance with scrub technique and ability to clear product from catheter hubs increased by 50%. The CLABSI rate in the first 9 months after intervention was 0.806 per 1000 line days as compared with 2.170 per 1000 line days in the previous fiscal year.ConclusionThe number of CLABSI’s during the intervention period was 63% less when compared with the previous fiscal year. This process, in conjunction with our other CLABSI prevention practices, has significantly decreased both our CLABSI rate and overall numbers. This project emphasizes the importance of focusing on the basics of infection prevention practices and continual auditing to prevent practice creep.Disclosures All authors: No reported disclosures.