“BUNDLES OF JOY”

The Reduction of CLABSI in a

Neonatal Unit

The Team

• E.M. Hudson – UM

• M. Leadsom – IPP

• S. Wortley - CF

• L. Matthews – CNS

• A. Nel – Neonatologist

• C. Thompson - PA

CONTEXT

• This intervention took place at Netcare CBMH in a 16

bedded Neonatal Unit.

• Has support of Nursing Staff

• Neonatologist

• Management

• Maternity M & M committee

PROBLEM

• Central lines are an essential part of neonatal care

• Neonatal CLABSI is a significant cause of morbidity and

mortality, increased treatment costs, prolonged

hospitalisation, anxiety for both parents and staff

• Despite the introduction of a central line insertion bundle in

June 2012, CLABSI continued to be a challenge

AIM

To elevate the level of care and

reduce the infection rate to zero

(from one every other month)

as soon as possible

for as long as possible

How was it implemented?

1. Learn from best practices 1. Staff and IPP

engagement

2. Reading from best practices in literature

2. Tools Generated

1. Blue central line insertion checklist

2. Yellow neonatal specific BCA campaign daily

monitoring form

3. Strategy

1. Daily audits

2. Feedback sessions at the PAB, ABS and maternity M&M

meetings

3. Staff awareness charts

4. Checking

1. Welsh Cross chart

2. Development of run charts

5. In order to Sustain

1. Collaboration with nursing and Dr’s

2. Continuous monitoring of days

between

INTERVENTION

• Central line infection rate assessed – previous record was 131

days between infections

• Jan 2014 – introduced a neonatal specific daily monitoring form

• A stringent hand hygiene campaign was commenced

• Central line assessed daily – dressing to remain clean, dry and

intact, the necessity for line & length of time in situ reviewed.

• Strategies: vigilant checking and measuring by means of a run

chart depicting days between infections & Welsh Crosses to

assess compliance with processes

INTERVENTION

Placement of lines:

• Use umbilical lines in exceptional circumstances only

• PICC lines - TPN and maintenance fluids

• Peripheral lines – used for antibiotics, blood products

• Avoid femoral lines altogether

Aseptic technique for all interventions

CENTRAL LINE INSERTION CHECKLIST

• Insertion site risk-assessed

• Practitioner gowned and gloved

• Patient covered with sterile drape

• Skin cleaned with 0.5% chlorhexidine in 70% isopropyl

alcohol

• Sterility maintained

• Sterile dressing applied

BCA CAMPAIGN DAILY MONITORING FORM

• Babies’ risk factors – (prematurity / immuno-compromised /

ruptured membranes, etc)

• The day the device was inserted

• The day the device was removed

• Type of device used – UVC , PICC

• Daily review of necessity of the line

• Reason for the device remaining in situ is documented

AUDITS

• 845 audits were done – became part of daily routine

• Unit manager and clinical nurse specialist did the initial

audits

• Central line insertion checklist is now performed by the

staff member allocated to the baby

• BCA daily monitoring form audit done by the shift leader

• Hand hygiene weekly audits performed by the hand

hygiene champion and students

STAFF HUDDLES

Days between CLABSI in Neonatal unit

0

100

200

300

400

500

600

700

Days B

etw

een

Series2 Series3

Daily CL

Bundle Audit

NNU Forum

Collaborative

630 days since last

CLABSI - last

infection in unit

3rd February 2014

BCA Daily

Monitoring Chart

Jan 2014

Maintenance bundle compliance

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Compliance to bundle Baseline

Staff did not document

why line remained in situ

WHAT DID WE LEARN?

Lessons learned

• Collaboration with colleagues is essential

• New processes need to be monitored and

measured daily – vigilance!

• Scepticism can be converted to success if you

have resolve and the results to prove it

Message to others

• Displaying, sharing and discussing information is

vital in order to keep everyone motivated to

improve patient care

REFERENCES

• CDC Guidelines for Prevention of Intra-vascular

Catheter-Related Infection, 2011

• Best Care Always 2009 and can be found on

http://www.bestcare.org.za

• 5 Million Lives campaign How-to-guide: Prevent

Central Line Infections [2008]