Reducing CLABSIs Through Team Empowerment: A 67% Reduction

Abstract

As a 250-bed regional pediatric medical center in New Orleans, Louisiana boasts a 36-bed Neonatal Intensive Care Unit (NICU) that experienced continual central line associated bloodstream infections (CLABSI) since January 2014. These infections were not associated with acuity, location within the unit, or a lack of adherence to basic infection control principles. By June 2014, it was determined that a more active approach was needed. In June 2014, a multidisciplinary team formed, including Infection Prevention, Quality Assessment and the NICU team to quickly and effectively tackle the infection rate. The team rapidly implemented strategic initiatives to include insertion and maintenance bundles, checklists, a dressing change team, a “buddy system” for tubing changes, use of sterile linens, chlorhexidine gluconate (CHG) bathing, daily assessment of device need with indication documented, a “kick the bucket” campaign, a “days since last CLABSI” poster, and root-cause-analyses from the Infection Preventionist (IP) for every infection. Using Excel, device days and infections were compared to before implementation (January to June 2014) and after (July to December 2014) to determine statistical significance of the strategies implemented. The adherence to the bundles, CHG bathing, and dressing changes was audited, with case reviews by the IP on any suspect or confirmed CLABSIs. The infections in NICU from January to June 2014 was compared to July – December 2014, with no statistical difference in device days. Process audits and case reviews showed excellent adherence to the initiatives, with staff feedback revealed a feeling of empowerment and in-control of preventing CLABSIs. By implementing bundle approaches and best practices to central line insertion and maintenance, the NICU experienced a 67% reduction in CLABSIs. This achievement has paved the way for the team to adopt these strategies house-wide.