Texas Children’s NICU 2 reaches 365 days and counting with zero CLABSI

January 10, 2017

11117clabsi640Texas Children’s neonatal intensive care unit (NICU) 2 nursing team has a big reason to celebrate – they reached 365 days and counting with zero central line-associated bloodstream infections (CLABSI), which demonstrates the value of team work and our hospital’s commitment to cultivating an environment for safe patient care.

In November 2015, NICU 2 reported three CLABSI infections. Since then, the rate of CLABSI occurrences has dropped to zero.

“Last fall, we were concerned about the number of CLABSIs we were having not only in the NICU but across the organization,” said NICU Clinical Nurse Specialist Alex Luton. “Together, with our infection control counterparts in education and vascular access, we implemented a massive educational initiative that trained more than 2,000 nurses across the organization on several key skills in central line care.”

Besides opening dialogue with the bedside nurses and care providers to identify and close any gaps observed around central line care, current hospital policies and practices were reviewed against national standards to identify areas of care that could be standardized to reduce CLABSI occurrences.

“Prior to this initiative, units had their own way of accessing and maintaining the central line,” said NICU Education Coordinator Rachel Leva. “Now, all nurses follow the same standard procedure for central line maintenance across the hospital system which has significantly helped us reduce our CLABSI rates in NICU 2.”

Creating the new role of central line resource nurses (CLRNs) has also provided an added layer of support for CLABSI prevention. To help bedside staff focus on other important patient care responsibilities, the CLRNs round on all patients with central lines during every shift.

“By providing central line care support and education, we’ve been able to address concerns early before they potentially manifest into a bloodstream infection,” said Ivy Lynn Ersan, a CLRN in NICU 2. “For instance, if a patient sweats a lot or has a lot of secretions, we may need to check on the patient more frequently per shift and change the dressing sooner than later to ward off an infection.”

Other strategies implemented in NICU 2 to reduce CLABSI include:

  • Central Line Champions Program – Specially trained to observe and audit central line care practices, these champions serve as coaches to ensure compliance with proven CLABSI prevention strategies. While all NICU staff are trained in CLABSI prevention, central line champions undergo more intensive training and must attend monthly educational sessions.
  • Hand Hygiene – NICU 2 nurses participated in a house-wide hand hygiene competition and posted signs in the unit as a visual cue to keep hand hygiene top of mind. NICU 2 leadership worked closely with Facilities to ensure ample supply of free standing hand sanitizer in the unit.
  • Weekly CLABSI meetings – Meetings are held every Tuesday to review and share information on CLABSI occurrence and identify any gaps in practice that need to be addressed. Attendees at these meetings include members from the vascular access, infection control and CLRN teams. A representative from Facilities also attends to ensure the working environment is conducive to safe patient care.

NICU 2 Assistant Clinical Director Tanya Williams says one important aspect that helped NICU 2 nurses achieve this milestone was their questioning attitude.

“Our nurses are not afraid to ask questions when something doesn’t seem right,” Williams said. “I think fostering this culture of a questioning attitude is how we were able to get this far. I am so incredibly proud of our nurses and our CLABSI partners for helping us achieve this patient safety milestone.”