365 days infection free: Congrats to the Brandon NICU & 4A/4AS Unit!
Every year, central line-associated bloodstream infections (CLABSI) lead to thousands of illnesses and deaths throughout the U.S. These serious, but common infections are caused when the catheter tube (central line) used to give patients medicines and fluids or collect blood samples, lets germs into the bloodstream.
Although CLABSIs are prevalent, they are still preventable. Last week, two of our units were recognized for going more than an entire year without one. The Nick and Chris Brandon Newborn Intensive Care Unit (NICU) at C.S. Mott Children’s Hospital and the 4A/4S Unit received the “365 Days of Safety Award” in a ceremony hosted by Jeff Desmond, M.D., interim chief medical officer, and Marge Calarco, Ph.D., RN, senior associate director and chief of nursing services.
“The focused work of these teams truly shows their true commitment to keeping our patients safe,” says Calarco.
“The 365 Days of Safety Award recognizes the tremendous efforts made by our teams in decreasing or eliminating hospital acquired infections,” adds Dr. Desmond. “It also provides an opportunity for teams to share improvement practices and opportunities.”
‘Scrubbing the Hub’
The 4A/4AS unit has been CLABSI-free since 2012. Staff on the 32-bed unit care for patients in Neurology and Neurosurgery services. 4A also includes a six-bed stroke unit.
“We are always striving to improve patient safety and outcomes,” says Cinda Loik, RN, BSN, MBA, nurse manager on the floor. She emphasized the culture of cleanliness that employees apply to their work area, specifically for CLABSI prevention.
One of the most important behaviors for their team members is cleaning the ‘hub,’ which is the cap at the end of central lines that comes in contact with the patient.
“’Scrubbing the Hub,’ seems to be engrained in our culture. It is stressed in orientation and even patients will comment, ‘oh, I see you’re scrubbing my hub.’”
During Multi-Disciplinary Rounds, nursing and medical staff in the unit also collaborate to decide whether a device or line could be removed. This includes central lines and Foley catheters.
“A culture of infection prevention”
The Newborn Intensive Care Unit at C.S. Mott Children’s Hospital is a 46-bed NICU caring for premature and sick newborn infants. Many patients require very specialized treatments.
A CLABSI can cause serious complications for an infant including increased length of stay, problems requiring longer use of a breathing machine, and even death of the patient. Because CLABSIs are fairly common, they were considered almost an accepted side effect in the field of neonatal medicine at one point in time.
“In 2008, we started a quality improvement initiative to reduce CLABSIs that focused on culture change,” says Sarah Poley, RN, leader of the initiative to reduce CLABSIs in the NICU. “We worked to change the belief that CLABSIs were inevitable to the mindset that just because a patient has a central line does not mean they will get an infection.”
“Our unit’s culture has evolved into one supportive of best practices for infection prevention,” she says. “We are receptive to new practices and modifications and regularly share lessons learned from past infections.”
Part of the unit’s improvement program was encouraging parents to join in the effort. Healthcare providers wore buttons with a caricature of a germ that said “Ask Me.” The buttons encouraged parents to ask about the button and to remind providers to wash their hands when they came in the room. Parents and visitors are also reminded to wash their hands frequently.
“When we distributed the buttons to our teams, each one included a card with the story of a patient who had a CLABSI,” she says. “That helped remind staff of the risks and potential complications. It helped everyone stay focused on reducing the number of infections. We are now invested in the belief that CLABSI’s truly are preventable.”