QUALITY
Background CLABSIs place patients at high risk for mortality and morbidity, increasing length of stay, and additional costly and detrimental therapeutic interventions. Our NICU historically ha..
more »QUALITY
Background CLABSIs place patients at high risk for mortality and morbidity, increasing length of stay, and additional costly and detrimental therapeutic interventions. Our NICU historically had a better than national average CLABSI rate, however, since 2022, our CLABSI rate spiked to above average. During this timeframe the unit experience higher census and acuity leading to increased workload and needs of patients and staff. In 2022, the CLABSI rate spiked from 0.53 in 2021 to 1.04 and 1.12 CLABSIs/1000 line days in 2022 and 2023, respectively.
MethodologyUtilizing Quality Improvement methodology allowed identification of the root cause of the increase in CLABSIs within our unit. After each CLABSI, a bedside review was completed identifying cause of infection. After evaluating trends, the majority of CLABSIs were due to skin or GI bacteria, highlighting a decrease in the unit’s environmental and personal hygiene practices. SMART Aim: Decrease CLABSI rate to “Days Since” in multidisciplinary daily huddle Transition to Five Moments of Hand Hygiene Availability of hand sanitizer on bedside carts Disposable curtain trial Midline implementation, decreasing central line days Bare Below the Elbows (BBE) and Wash, Wipe, Wear (3Ws) – nothing below the elbow, improved environmental hygiene, and effective hand washing
OutcomesAfter implementation of interventions identified, intentional auditing, and Just In Time Training, hand hygiene compliance increased to >95% consistently for all moments of hand hygiene. Identifying gaps and barriers in cleanliness allowed interventions to be implemented and PDSA cycles allowed for improvement in compliance. The NICU went 230 days CLABSI free starting November 2023. Currently for 2024, the rate is 0.46 CLABSIs/1000 line days.
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