747 - CLABSI Zero x 2years in a level 4 nicu using QI methodology, multidisciplinary team approach and visual tools.

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 747
Publication Number: 747.343

Deepali Handa, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States

Presenting Author(s)

DH

Deepali Handa, MD MBA (she/her/hers)

Clinical Assistant Professor of Pediatrics
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, New York, United States

Background: Many neonates in the NICU require central lines for extended periods of time to supply adequate nutrition and medications. Often umbilical lines are placed initially followed by Peripherally inserted central catheters (PICC). There are multiple publications highlighting the increase in mortality, morbidity and length of stay in neonates with Central Line Associated Blood Stream Infection (CLABSI). We are a busy Regional Perinatal Center with ~900 admissions annually in our level 4 NICU. In our unit, we have PICC bundles, standardized processes & guidelines for discontinuing PICC at 120ml/kg/d enteral nutrition in place for a couple of years to minimize CLABSI. We also have a core PICC nursing team who inserts and maintains the sterile dressing integrity till discontinuation. Despite the above measures in place, we had 4 CLABSI cases in Nov 2020 which led to this QI project

Objective: To bring incidence of CLABSI from four in Nov 2020 to zero by Dec 2021 and to continue the trend for >1 year

Design/Methods: We created a multidisciplinary team that included the NICU Medical Director, NICU Nursing Educator, Nursing Managers, PICC line Nurses and Infection Prevention team. We met over multiple meetings and utilized QI methodologies like A3 worksheets (Fig 1) and 5-whys to deep-dive into the reasons behind the last 4 CLABSIs. Based on the analysis, and extensive literature review we proposed changes and timeline to implement them. We started placing the no. of PICC line days on the patient room doors to highlight dwell time to both physician and nursing teams to encourage discussion around necessity during rounds and signouts (Fig 2). We created guidelines for enhanced vigilance past 30 days and recommended replacement with a new PICC line post 42 days dwell-time. Multiple education sessions were done separately with all teams to highlight the new processes. Periodic audits were done to assess the procedures and processes and feedback was given to bedside teams

Results: We have been CLABSI zero for 2 years in Nov 2022. During this time frame, >600 central lines have been placed and maintained for >10,000 central line days. PICC line dwell time has decreased significantly as well

Conclusion(s):

Utilizing QI methodologies used by other industries, like A3 worksheets and visual tools, along with multidisciplinary approach, has been helpful in achieving this milestone in our busy regional level 4 NICU