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Reducing Neonatal Central Line Infections with the Implementation of a Maintenance Bundle
Abstract
Problem: Central line-associated bloodstream infections (CLABSIs) were identified as a concern in a large academic-level IV NICU, as evidenced by CLABSI rates exceeding the standardized infection ratio (SIR) for four of ten quarterly reports. To reduce CLABSIs in the neonatal population, government agencies recommend bundled interventions. Purpose: This quality improvement (QI) initiative aims to implement a central line maintenance bundle adapted from The Joint Commission’s central line checklist for the neonatal population to eliminate CLABSI rates and promote safety through early identification of central venous catheter (CVC) management needs. Methods: A central line maintenance bundle was adopted over a 15-week implementation period. To achieve process measure goals, in-person education sessions, module-based instruction on bundle components, and aseptic non-touch technique (ANTTÓ) were utilized, unit champions were prepared, and daily chart audits were conducted. Nurses completed the central line bundle by scanning a QR code linked to REDCap during night and day shifts. Nurses (n=148), attending (n=15), and fellows (n=4) were educated on the central line bundle. Results: Approximately 1,057 central-line days were observed during the 15-week CVC maintenance bundle implementation period. Following implementation, central line bundle compliance increased to an average of 34% during day shifts and 15% during night shifts. When looking at individual bundle components, the results indicate 58.3% compliance with the assessment of the line during interdisciplinary rounds, 99.6% compliance for the use of disinfecting Curos caps, 90.7% compliance for maintaining dressing integrity and prompt dressing changes, 99.7% compliance for tubing labeling, and a 50.7% adherence to ANTT®. CLABSI rates decreased by 100% compared to quarterly data before implementation. Conclusion: Implementation of the CVC maintenance bundle enhances standardization in central line care, facilitating early recognition of CVC-related clinical needs and mitigating the risk of CLABSIs.Identifier to cite or link to this item
http://hdl.handle.net/10713/22748Collections
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