Presentation at APIC by Catawba Valley Medical Center

Attaining Zero Catheter Associated Bloodstream Infections in a Level III Nursery

Mrs. Michelle Mace, MSN, RN, CIC - Administrator, Infection Prevention, Catawba Valley Medical Center Ms. Andrea Flynn, MS, BSN, RNC - Clinical Development Coordinator, Nurseries and Pediatrics, Catawba Valley Medical Center

The Special Care Nursery (SCN) at a community Magnet hospital had a total of nine Catheter Associated Blood Stream Infections (CABSIs) from January 2008 to August 2009.

Infection Prevention and Control Programs

The Special Care Nursery (SCN) is a 12-bed Level III Nursery within a 258-bed, not-for-profit, Magnet hospital located in North Carolina that offers a full range of medical services and specialties to a 5-county region. From September 2009-June 2010, the SCN participated with the Perinatal Quality Collaborative of North Carolina (PQCNC) in a project to decrease CABSIs in neonates. A total of 13 intensive care nurseries participated. While the SCN CABSI rate was considered low for a unit of its size, even one CABSI was too many. The PDSA (Plan, Do, Study, Act) cycle for process improvement for the SCN included implementing new evidence-based practices to decrease the chance of infections. These practices included: . Discontinuing the central lines as soon as possible (to decrease the possibility of an infection occurring), .
Using sterile gloves during tubing changes (to maintain line sterility), . Applying 3.15% Chlorhexidine on hubs, 2% Chlorhexidine on infants that qualify (a more effective skin disinfectant), . Utilizing a closed system for umbilical arterial catheters (less likely to cause an infection), and . Obtaining a dedicated X-ray machine that stays in the SCN (to prevent contamination throughout the hospital). During the duration of this project, nurses completed forms every shift documenting insertion and maintenance techniques. Chart audits, observations and data entry ensured compliance from nurses, mid-level practitioners and physicians.

The goal for this project from September 2009-June 2010 was to decrease the CABSI infections by 50%. This goal was met, and exceeded in the months to follow. In 2010, the SCN had 2 CABSIs, with a rate of 3.19. In 2011, the SCN had zero CABSIs. Overall, the PQCNC experienced a 62% decrease in CABSIs across the state, which is equivalent to approximately 8 lives and 2 ½ million dollars saved. While the collaborative initiative ended in June 2010, the SCN continued the practice changes that were made and celebrated one year with zero CABSIs on November 2, 2011. We have now started the second project with PQCNC, and expect continued success.

Lesson Learned
While the SCN had a very low rate of CABSIs in previous years, it is now known that having zero CABSIs is achievable. The evidence based practices that were put into practice will continue and new ideas will be implemented to prevent CABSIs in neonates.