Main Menu Browse by Day or Program Author Keywords

494 A Successful Intervention to Prevent CLABSI in the Neonatal Intensive Care Unit

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Judith Guzman-Cottrill, DO , Oregon Health and Science University, Portland, OR
Kris Farrimond, RN, MSN , Oregon Health and Science University, Portland, OR
Ann Stepto, NNP , Oregon Health and Science University, Portland, OR
Molly Hale, MPH, CIC , Oregon Health and Science University, Portland, OR
Emily Ackiss, MPH, CIC , Oregon Health and Science University, Portland, OR
Kevin Langstaff , Oregon Health and Science University, Portland, OR
Robert Schelonka, MD , Oregon Health and Science University, Portland, OR
Background: Central line-associated bloodstream infections (CLABSI) cause significant morbidity and mortality in the neonatal intensive care unit (NICU) population.  In 2008 and early 2009, routine infection control surveillance of our NICU revealed an increase in CLABSI rate from baseline.

Objective: To determine if a potentially better practice of two-person sterile technique for daily intravenous (IV) tubing changes would decrease the CLABSI rate in our level IIIc NICU located within a large, urban teaching hospital.

Methods: Beginning March 2009, the NICU quality improvement team implemented a change in practice to begin sterile IV tubing changes for all infants hospitalized in the NICU.  Routine daily IV tubing changes are performed in a sterile field with primary and secondary nurses; the secondary nurse assists during the procedure to ensure that a sterile field is maintained throughout the tubing change procedure. Both nurses wear a surgical cap, procedure mask, and sterile gloves.  The hospital Infection Prevention and Control Program routinely surveys all infections in hospitalized infants and shares CLABSI data on a weekly basis with the unit’s medical and nursing staff.

Results: For an 11 month period (January 2008 through February 2009) prior to implementation of the intervention, the NICU CLABSI rate was 4.50 per 1,000 catheter days. Since introducing this new protocol, the CLABSI rate over a 20 month period (March 2009 through October 2010) fell to 0.75 per 1,000 catheter days (p=0.001). Since full implementation of sterile technique for IV tubing changes, the unit has remained CLABSI-free for 10 consecutive months (since January, 2010).

Conclusions: After introduction of this intervention into our NICU, there have been no CLABSIs for ten consecutive months. This practice of sterile IV tubing changes in our population was associated with a marked reduction in CLABSI rate, and should be studied in other patient populations as a potentially effective strategy to prevent CLABSI.