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From Concern to Control: Feedback from a quality improvement project to decrease Central-Line-Associated Bloodstream
Nabiha Ahmad Bouafia1, Ahmed Elabbasy2, Dalal Albukhari3
1Infection Prevention and Control Centre of Excellence - Prince Sultan Military Medical City - Riyadh 12233, Kingdom of Saudi Arabia. University of Sousse - Faculty of Medicine - Sousse 4002, Tunisia.
Insights
Implementing a quality improvement project significantly reduced central line-associated bloodstream infections (CLABSI) in a Neonatal Intensive Care Unit (NICU). This initiative improved care quality and newborn outcomes by adhering to updated recommendations.
Area of Science:
- Neonatal Intensive Care
- Infection Prevention and Control
- Quality Improvement Science
Background:
- Neonatal Intensive Care Units (NICUs) present a high risk for central line-associated bloodstream infections (CLABSI) in infants.
- Existing CLABSI rates necessitate targeted interventions to meet national healthcare benchmarks.
Purpose of the Study:
- To implement a quality improvement project (QIP) aimed at reducing CLABSI rates in a NICU setting.
- To achieve the Saudi Ministry of Health (MOH) benchmark for CLABSI incidence.
Main Methods:
- A quality improvement project utilizing the Plan-Do-Check-Act methodology was conducted in a NICU.
- An interdisciplinary team focused on evidence-based recommendations and supply chain management for central line care.
- Staff compliance with updated protocols and care bundles was monitored over six months.
Main Results:
- Vascular access team implementation led to increased compliance with updated recommendations (25% to 56.3%) and care bundles (66.07% to 79.12%).
- Improved availability of central line supplies was noted.
- A significant reduction in CLABSI rate by 82.3% was achieved, decreasing from 10.42 to 1.84 per 1,000 central line days.
Conclusions:
- Quality improvement projects based on updated recommendations are effective in reducing CLABSI rates and enhancing neonatal outcomes.
- Sustaining low CLABSI rates requires addressing challenges and continuous monitoring.
- Evidence-based practices and dedicated teams are crucial for improving neonatal care quality.
Introduction:
Infants admitted in Neonatal Intensive Care units (NICU) are frequently exposed to a high risk of contracting a central line-associated bloodstream infection (CLABSI). The study aims to reduce the CLABSI rate in the NICU to reach the Saudi Ministry of Health (MOH) benchmark.
Methods:
It is a quality improvement project based on the Plan Do Check Act. This study was conducted in the Neonatal intensive care unit (NICU) at the Prince Sultan Military Medical City. The study was done from February 2023 to July 2023 in NICU. Sixteen evidence-based recommendations were assessed over the project. An assigned team enhanced the regular assessment of central line-related items and supplies.
Results:
38 staff members were selected as 'a vascular access team' for this project. Full compliance with updated recommendations increased from 25% to 56.3%, and overall care bundle compliance improved from 66.07% to 79.12%. The availability of supplies related to central lines improved throughout the CLABSI project. Consequently, the CLABSI rate decreased by 82.3%, from 10.42 (6 CLABSI, 576 central line days; February 2023) to 1.84 (1 CLABSI, 544 central line days; July 2023) CLABSI per 1,000 central line days after six months of quality improvement project implementation.
Conclusions:
Reducing the CLABSI rate is achievable by QIP based on updated recommendations to improve the quality of care and outcomes for newborns. However, multiple challenges should be addressed to maintain a low CLABSI rate.
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