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166 Is It Possible To Go A Year Without A Central Line Associated Bloodstream Infection In A Neonatal Intensive Care Unit?

Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Lynne Karanfil, RN, MA, CIC , MedStar Health, Columbia, MD
Cheryl A. Wood, RN, BSN, NNP-BC , Franklin Square Hospital Center, Baltimore, MD
Laurie Sanza, RN, BSN, CIC , Franklin Square Hospital Center, Baltimore, MD
Gerri Petit, RN, BSN, NNP-BC , Franklin Square Hospital Center, Baltimore, MD
Sita Kottapalli, MD , Franklin Square Hospital Center, Baltimore, MD
Stacey Bell, RN , Franklin Square Hospital Center, Baltimore, MD
Background: Reports of using the central line bundle to achieve zero central line associated bloodstream infections (CLABSI) in the adult population have been well established. Yet using this methodology in the neonate, one of the most vulnerable patient populations and the results of the bundle’s affect is lacking. The National Healthcare Safety Network (NHSN) indicate a rate as high as 9.0 CLABSIs per 1000 central line days in neonates less 750 grams. A review of the literature showed addressing reducing neonatal CLABSI indicated the latest article was published in 2005. This article reported low rates experienced at a site that used a closed medication system which is now a common practice. Objective: To implement central line and aseptic practice changes and study their resultant effect in reducing CLABSIs in our tertiary care, 23 bed neonatal intensive care unit and report data using the NHSN birthweight strata. Methods: A collaborative approach using a multidisciplinary team begun in July 2007 and was completed by November 2008. The approach addressed four key areas; equipment, environment, hand hygiene and education. Changes in the policy for hub cleaning, using an in line blood drawing device, hand hygiene monitoring and reporting were established. Finally education around practices in nutrition, skin care, central line bundle adherence, PICC line insertion and maintenance were accomplished. Results: In FYs 2007-2009 CLABSI data indicated the following:
 

All Weight Classes

FY07
FY08
FY09
# CLABSI
5
1
0
# Central line days
431
332
386
Rate/1000 central line days
11.6
3.01
0.0
Results:

In FY09, there were zero CLABSIs in the NICU.

Conclusions: A collaborative approach involving all disciplines using established protocols in adults can also be effective in achieving a zero rate of CLABSIs in the neonate. Our center has gone over 24 months without a single CLABSI in this high risk population.