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Implementation of a NICU Central Line Bundle: Practice Changes Associated with a Decrease in Infection Rates

Saturday, 29 October 2011

Pam S. McKinley, RN, BSN1
Arpitha Chiruvolu, MD2
Regina Reynolds, RNC3
Kim Miklis, MSN2
(1)Department of Neonatology, Baylor University Medical Center, Dallas, TX
(2)Neonatology, Baylor University Medical Center, Dallas, TX
(3)Womens & Childrens, Baylor University Medical Center, Dallas, TX

Learning Objective 1: The learner will be able to state the most effective ways to reduce catheter associated infections

Learning Objective 2: The learner will be able to identify strategies for managing the process of improvement

Type of Evidence used and Synthesized

Our goal is to reduce nosocomial infection rates in the NICU through the investigation and implementation of evidence-based methodologies published in literature, such as the Vermont Oxford Network recommendations and the IHI Central Line Bundle. Since our implementation of the central line bundle, central line infections have been reduced by more than 89%.

Improvement Implementation Strategy

Better Practice Implementation

  1. Maximal Barrier precautions with central line insertion
  2. Dedicated nurse-led team for central line placement and maintenance
  3. Hand hygiene guidelines
  4. Staff empowered to stop non-emergent procedure if sterile technique is broken
  5. Daily assessment of catheter need
  6. Daily review of dressing integrity and site cleanliness
  7. Use of closed system for infusion and medication administration

Evaluation Method

Employing PDCA methodology, our multidisciplinary team met regularly to:

  1. Review the best practices from the literature
  2. Benchmark
  3. Achieve consensus on definition of a line infection
  4. Track progress (compliance to bundle, CR-BSI rates/1000 line days, total number of line days)

Outcomes/Results

The fact that our nosocomial infection rate significantly improved in less than a year after best practice implementation, despite an increase in patient load, supports the effectiveness of the evidence-based practice “bundle” approach to improving health outcomes.

1.  2007 CL-BSI Rate = 10.56/1000 lines days (prior to bundle implementation)

2.  2008 CL-BSI Rate = 3.07/1000 line days (21 CR-BSI Infections)

3.  2009 CL-BSI Rate = 1.47/1000 line days (10 CR-BSI Infections)

4. 2010 CL-BSI Rate = 1.14/1000 line days (6 CR-BSI Infections)

5. Unit Savings from 2008 to 2010 = 15 x $17,878.00, or approximately $268,000.

 

See more of: Poster Session I
See more of: Oral Paper & Poster: Evidence-Based Practice Contest