Development of an Infection Prevention Link-Group Program in the Neonatal Intensive Care Unit (NICU) – a Collaborative and Supportive Team toward Zero Tolerance

Background: : Increasing bloodstream and density infection rates in the NICU and low adherence to hand hygiene have challenged both the Infection Control Team and the NICU staff to adopt a transformational management infection program.

Objective: To describe the setting up and development of an infection prevention link-group system in order to reduce healthcare associated infections (HAI) in the NICU.

Methods: This strategic and collaborative quality improvement among multidisciplinary professionals within the NICU was carried out in a 12-bed NICU level 3D of a private hospital in São Paulo, Brazil. The focused planning on infection reduction was established in 2006. Three subgroups were formed to carry out the improvement process for a specific aim: reduce 25% of CVC associated bloodstream infection and ventilator associated pneumonia; and reach 80% hand hygiene adherence. The cultural technical and structural changes were performed using a PDCA (Plan, Do, Check and Act) tool. Each group reviewed the literature, revised the structure and the processes of patient care related to vascular access and ventilator care and also hand hygiene. Healthcare workers took part in educational sessions and nurses demonstrated care practice competencies.

Results: There was 68.5% reduction of CVC associated bloodstream infection and 54.4% of density infection rate (Jan – Sep 2009). There were 2 ventilator associated pneumonia events: one in 2007 and one in 2008; none from Jan – Sep 2009. The hand hygiene adherence increased from 58.5% (Dec 2006) to 84.8% (Aug 2009).

Conclusions: The Infection Prevention Link-Group Program using a collaborative and multidisciplinary approach contributed to a continuous reduction of HAI in the NICU.