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Protecting our Littlest Victors

NICU celebrates 365+ days without a CLABSI

NICU central lineThere was a time when central line blood stream infections (CLABSI) were historically accepted as inevitable and the source of significant medical morbidity and costs.

Today, though, staff, patients and families at Mott are celebrating a remarkable achievement. Thanks to a focused team effort, the Nick and Chris Brandon Newborn Intensive Care Unit (NICU) at C.S. Mott Children’s Hospital has gone more than one year without an infection.

The line basics

A central line is a catheter that is inserted into a patient’s vein in his or her arm, leg, neck or – in the case of newborns – an umibilical blood vessel. The line is used to administer medication, supply nutrition to the patient, give large amounts of fluid or blood, and take blood samples without having to stick the patient with a needle. Central lines can stay in place longer than a standard IV.

Depending on what causes the CLABSI and the health of the patient, the infection can be very serious. Premature infants in the NICU, especially, are at a higher risk for serious complications. A CLABSI can significantly prolong the length of stay in the NICU, cause breathing problems that require extended use of a breathing machine, and even lead to the death of the patient.

Making changes

Because CLABSIs were fairly common, they were considered almost an accepted side effect in the field of neonatal medicine at one point in time.

“Back in 2008 when we started this quality improvement initiative to reduce the number of CLABSIs, we knew we had to focus on a culture change. We worked to change the mindset that just because a patient had a central line, didn’t mean they would get a CLABSI,” says Sarah Poley, RN, and leader of the initiative to reduce the number of CLABSIs.

The team focused on a series of practice changes including careful insertion technique, meticulous maintenance of the line and removal of the line when it was no longer needed. In addition, many of a particular type of central line are now inserted by a special NICU based nursing team, who take great care and pride in their work.

“We used to keep the lines in longer just in case we would need it again. Now we remove it sooner rather than later,” says Michelle Nemshak, MSN, RNC-NIC, Clinical Nurse Specialist. “The longer a line stays in, the more likely it is to get infected. If you don’t have a central line you can’t have a central line infection.”

Families as members of the team, putting a face on the problem.

Hand washing is critical to reducing CLABSI. Part of the rollout of this quality improvement program was empowering parents to join in the effort. All healthcare providers wore buttons with a caricature of a germ that said, “Ask Me.” The buttons encouraged parents to ask about the button and to remind providers to wash their hands when they came in the room. Parents and any other visitors are also reminded to wash their hands frequently.

“When we distributed the buttons internally, each one included a card with the story of a patient who had a CLABSI,” says Poley. “That helped remind staff of the CLABSI risks and potential complications. It helped everyone stay focused on reducing the number of infections.”

Training for excellence

All 120 nurses who work in the NICU were also trained on a sterile setup for delivering lipids and TPN (nutrition delivered through the IV line). Because of the nature of those fluids and because they are changed frequently, it was important to make sure they were being delivered safely and in a standard fashion. They also receive ongoing training on line maintenance.

Making a difference

“The single most important thing that helped make a difference and this effort a success is the culture of caring,” says Robert Schumacher, MD, Neonatologist and Medical Director of the NICU. “Sarah and Michelle have led the quality and safety effort and given the staff the motivation and tools to be successful. Sarah reviews every single CLABSI we’ve had to identify what happened and take steps to prevent it in the future.”

The number of CLABSIs in the Mott NICU has been on the decline since 2008. In 2007, there were 47 line infections. In 2008, that number dropped to 23. The number has been on the decline every year since then even though the number of line days (the number of days patients have a central line in place) has continued to increase. There have been more than 6,000 line days in the past year since the last CLABSI in the NICU.

The NICU is the largest ICU in the University of Michigan Health System. They are sharing their expertise and team success with colleagues across the system to reduce the number of CLABSIs in all ICUs.

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Best Children's Hospitals - C.S. Mott Children's HospitalUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.