The purpose of this initiative is to decrease and/or eliminate central line-associated bloodstream infections (CLABSI) in the neonatal intensive care unit (NICU) at Aurora Bay Care Medical Center. Hospital acquired infections, including CLABSI, is a major cause of mortality, prolonged hospitalization, and extra costs for NICU patients (Stevens & Schulman, 2012). The goal of this initiative is to decrease CLABSI by 75% by reducing the number of days lines are in and standardizing the insertion process and line maintenance. CLABSI is preventable and increases the risk of neurodevelopmental impairment in very low birth weight infants. It is estimated that up to 70% of hospital acquired infections are caused by CLABSI in preterm infants (Stevens & Schulman, 2012). It is also estimated that 41,000 CLABSI occur in United States hospitals every year (Centers for Disease Control and Prevention [CDC], 2012).
It is easily preventable by managing the central line properly. Insertion of the central line must be done completely sterile and rigorous care needs to be done with catheter care. The catheter hub is the main culprit of infections so that needs to be a large part of the initiative (Stevens & Schulman, 2012). The participants in this initiative include neonatologists, neonatal nurse practitioners, nurses, infection control personnel, the NICU supervisor, and the NICU manager. Together, they will form a core team of 10 people with at least one person from each level of care. The team will analyze the NICU practices and establish practice based on evidenced based practice. The team will investigate the cause of each infection and agree on changes that need to be made. They will meet every other week until the new practices have been established, at which time they can determine how often they need to meet.
Each member must play an active role in the investigation process as well as the agreed-upon changes. There are multiple benefits to the proposed initiative. Hospital acquired infections will be reduced which means there will be a reduction in harm to the patients. This will mean a major cost savings to Aurora Bay Care Medical Center because there will not be that additional cost of treating a preventable infection. Staff will be collaborating together for the greater good of the NICU. The best practices that come out of the initiative can be shared with other NICUs to help decrease CLABSI across all hospitals. The cost of the initiative will be minimal compared to the cost of treating a CLABSI. On top of the morbidity and mortality resulting from the infection, the financial costs are significant. Many of these costs are no longer covered by insurance because the infection was a result of the hospital stay.
The CDC recently estimated the cost of a CLABSI to be $29,156 per case with an estimated mortality of 12-25% (Horan, 2010). The largest cost that will incur because of this initiative will be staffing costs. The team of approximately 10 people will get paid for their time on the team that will meet every other week for an undetermined amount of time, not to exceed 3 months. Any time spent on research will need to be reimbursed. The entire staff will need to be trained on the new processes before they are rolled out. They will be required to do hands on training as well as complete a competency designed by the team. There will not be an increase in the cost of supplies, as the NICU has all the supplies necessary at this time. If it is determined they need different supplies, it will be addressed at that time.
Data definitions and the procedures used for collection will be determined by the team at the first meeting. The data will be tracked from the first day the team meets throughout the course of the quality initiative. The original goal will be to decrease CLABSI by 75% in the first year. A detailed analysis must be performed on the processes that were used to implement and maintain evidence-based practices. Each infection must have an investigational analysis completed.
The data that is collected will be completely confidential so as to not break the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rules. In conclusion, the purpose of this initiative is to reduce CLABSI by at least 75% in the NICU at Aurora Bay Care Medical Center. This will be accomplished through training and education to the doctors, nurses, any staff that comes into contact with the infants, and the parents. This is a win-win for both the patients as well as the hospital because it will reduce morbidities and mortalities caused by the preventable infection as well as reduce costs significantly for the hospital.
Centers for Disease Control and Prevention. (2012). Central line-associated bloodstream infection (CLABSI) event. Retrieved from http://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf Horan, T. C. (2010). Central line-associated bloodstream infection (CLABSI) criteria and case studies. Retrieved from http://www.azdhs.gov/phs/oids/hai/documents/NHSN_Workshop1_CLABSI_Criteria_Studies.pdf Stevens, T. P., & Schulman, J. (2012). Evidence-based approach to preventing central line-associated blood stream infection in the NICU. Acta Paeditrica, 11-16. doi:10.1111/j.1651-2227.2011.02547.x