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Central line "attention" is their best prevention
Tammy Kime1, Khawar Mohsini, Martin U Nwankwo
1Covenant Healthcare, Saginaw, Michigan, USA. trkime@yahoo.com
Insights
Implementing standardized central line care in a neonatal intensive care unit (NICU) significantly reduced central line-associated blood stream infections (CLABSI). This initiative improved patient outcomes and adherence to best practices.
Area of Science:
- Healthcare Quality Improvement
- Infection Prevention and Control
- Neonatal Intensive Care
Background:
- Central line-associated blood stream infections (CLABSI) increase patient morbidity, mortality, and healthcare costs.
- A Level III neonatal intensive care unit (NICU) experienced a rise in CLABSI rates in 2009.
- Lack of standardized central line management practices preceded the initiative.
Purpose of the Study:
- To evaluate the impact of a standardized central line management initiative on CLABSI rates in a NICU.
- To assess changes in length of stay and adherence to new policies.
- To identify risk factors associated with CLABSI in the NICU population.
Main Methods:
- Retrospective review of CLABSI incidence six months before and three months after policy implementation.
- Phased implementation of standardized practices: hand hygiene, "scrub the hub", tubing changes, and insertion/removal/dressing protocols.
- Measurement of CLABSI incidence, length of stay, and policy adherence.
Main Results:
- Clinically significant reduction in CLABSI rate from 15.6% per 1000 line days to 0% in 2010.
- Increased adherence to standardized central line care policies.
- Identified a correlation: each additional week of patient stay increased CLABSI risk sevenfold.
Conclusions:
- Standardized central line management is effective in reducing CLABSI in NICU settings.
- Adherence to best practices significantly mitigates infection risk and improves patient safety.
- Multifaceted approach involving hand hygiene and line care protocols is crucial for infection control.
Abstract:
Central line associated blood stream infections (CLABIs) are associated with an increase in length of stay, morbidity, hospital costs, and mortality. In 2009, CLABIs were on the increase at Covenant Healthcare's 55 bed Level III neonatal intensive care unit (NICU). Prior to this practice initiative, there were no standardized central line management practices in the NICU. We retrospectively reviewed the incidence CLABIs for the six months prior to the initiation of the standardization of central line management and then 3 months following the implementation of the new practice policy. Specific outcomes measured were the number of CLABIs, length of stay related to CLABIs, and adherence to the policies and procedures. The project was implemented in four phases: 1) hand hygiene, 2) "scrub the hub", 3) central line tubing changes, 4) central line insertion, removal, and dressing changes. Although there were no statistically significant changes in the outcome measures, there were clinically significant differences between length of stay and risk for central line infection, incidence of CLABIs, and an increase in adherence to the central line practice change policies. The study showed for every week that is added to the patient stay, the patient was 7 times more likely to have a CLABIs. The rate of central line infection was decreased from 15.6 percent per 1000 line days to zero in 2010.
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