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Reduction of Central-line-Associated Bloodstream Infections in a Tertiary Neonatal Intensive Care Unit through
Hannah B Hightower1, John Andrew Young2, Jennifer Thomas2
1From the University of Alabama at Birmingham, Birmingham, Ala.
Insights
Simulation-based training significantly reduced central line-associated bloodstream infections (CLABSIs) in critically ill neonates. This approach, combining education and simulation, proved more effective than standard methods for sustained CLABSI reduction.
Area of Science:
- Neonatal Intensive Care
- Infectious Disease Prevention
- Medical Education
Background:
- Central venous lines (CVLs) are vital for critically ill neonates but increase the risk of central line-associated bloodstream infections (CLABSIs).
- CLABSIs lead to significant patient morbidity, mortality, and increased healthcare costs.
- Sustained reduction of CLABSIs has been challenging despite standardized care bundles.
Purpose of the Study:
- To evaluate the effectiveness of simulation-based nursing training in reducing CLABSI rates in a Neonatal Intensive Care Unit (NICU).
- To compare the impact of different educational interventions on CLABSI rates.
Main Methods:
- A retrospective study included all neonates with CVLs admitted to the NICU between 2014 and 2020.
- CLABSI events and CVL days were recorded.
- Simulation-based nursing training for CVL care was implemented in late 2016, following initial implementation of Job Instruction Sheets and one-on-one teaching.
Main Results:
- Initial interventions (Job Instruction Sheets, one-on-one teaching, audits) did not significantly decrease CLABSI rates.
- Following the introduction of simulation-based training in 2016, a sustained decrease in CLABSI events per 1000 line days was observed (x = 0.692).
Conclusions:
- Standardized care bundles and audits alone were insufficient to reduce CLABSI rates.
- Combining care bundles with education and simulation-based training significantly decreased CLABSI rates.
- Supervised, interactive education coupled with simulation is critical for achieving sustained improvements in patient outcomes and reducing CLABSIs.
Introduction:
Critically ill neonates and those with complex medical conditions frequently require the use of central venous lines. Unfortunately, central line-associated bloodstream infections (CLABSIs) result in significant morbidity and mortality, and the cost and increased length of stay burden the healthcare system. Previous studies have demonstrated that standardized care bundles can decrease CLABSI rates, but achieving sustained improvement has proven difficult.
Methods:
All patients admitted to the Neonatal Intensive Care Unit between 2014 and 2020 who had a CVL were included in this study. First, we recorded all CLABSI events and total CVL days according to defined criteria. Then, in late 2016, we instituted simulation-based nursing training for CVL care.
Results:
Job Instruction Sheets were initially introduced to Neonatal Intensive Care Unit nursing staff simultaneously with one-on-one teaching sessions between instructors and bedside nurses. Intermittent performance audits and re-education for identified deficiencies did not improve the CLABSI rate per 1000 line days. After instituting simulation-based CVL training in 2016, there was a decreased rate of CLABSI events per 1000 line days sustained over time (x = 0.692).
Conclusions:
Standardized care bundles and Hospital-acquired Condition interactor audits were insufficient to reduce the CLABSI rate. However, combining care bundles and education with simulation-based training significantly decreased CLABSI rates. One-on-one intensive training and continued ongoing monitoring were critical to producing a sustained reduction. This experience demonstrates that supervised, interactive education combined with simulation can significantly impact patient outcomes.
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