Implementation of an Electronic Hand Hygiene Monitoring System in Pediatric Long-term Care Facilities

Abstract

ISSUE: Central Line-Associated Bloodstream Infections (CLABSIs) result in increased morbidity, mortality, and length of stay in Neonatal Intensive Care Unit (NICU) patients. The CLABSI rates in a level II and III NICUwere consistently greater than 5.4 (CLABSI/1000 device days) and peaked at a rate of 10.7 in 2010. To address this problem an “Aim for Zero” task force was created which included nurses, directors, infection control, and physicians, and implemented a central line team. PROJECT: The task force and central line team analyzed all bloodstream infections in the NICU. In September 2010 the line team began training with evidence based practice techniques for the care of all umbilical, peripherally inserted, and operating room inserted central catheters. Daily rounding and assessment of these lines was implemented as well as strict sterile insertion practices, dressing maintenance, daily sterile fluid changes, and a timely removal process. Sterile injection ports were added to all lines and a 30 second scrub with 3% chlorahexadine was performed prior to every access. The line team was officially launched in November, 2010. RESULTS: Immediately after implementing changes CLABSI rates dropped significantly. From December 2010 through November 2013 the NICU units recorded 25,000 central line days and 132,546 patient days and had a CLABSI rate of 0.65. Our longest CLABSI free stretch was 304 days ending in October of 2013. Our peripherally inserted and umbilical lines remain CLABSI free to date. It is important to note that our data is accurate as we do not use any maneuvers to avoid National Healthcare Safety Network (NHSN) CLABSI criteria.