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Description
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.
Methodology
Utilizing 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 <0.9 CLABSIs/1000 line days by December 2024. To improve overall cleanliness and awareness within the unit, interventions put into place included:
- “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
Outcomes
After 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.
Publication Date
9-27-2024
Keywords
CLABSI, NICU, Hand Hygiene, Environmental Hygiene
Disciplines
Pediatric Nursing
Recommended Citation
Palmer, Rebecca; Lanehart, Kymeyone; Tidwell, Jerithea; Yallapragada, Sushmita; Gaines, Jeanne; and Campbell, Courtney, "Mindful Cleanliness: Resetting Expectations for Environmental and Personal Hygiene to Reduce the CLABSI Rate in a Level IV NICU" (2024). 2024. 12.
https://scholarlycollection.childrens.com/nursing-anf2024/12
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
