Prevention of Nosocomial Infection in the Neonate; Targeting Central Venous Catheter Bloodstream Infections (CVC-BSI)

Since 2001, a team approach to practice change has resulted in the implementation of quality improvement activities targeting insertion and maintenance care of invasive central venous catheters (CVCs). In 2010, CVC-BSI rates in NICU were reduced in 3 out of 4 weight categories to below the National Healthcare Safety Network (NHSN) benchmark levels. Between fall 2010 and spring 2011, surveillance of CVC-BSIs revealed 5 infection-free months. Actions are described as “care bundles,” a concept introduced by the Institute for Healthcare Improvement. Components of the CVC insertion bundle include a hand hygiene program, infection prevention staff education, standardization of catheter insertion technique, optimal site selection, chlorhexidine gluconate for skin antisepsis, formation of a dedicated CVC insertion team, standardized equipment cart for vascular access, attention to maximum sterile barrier precautions, and the removal of stopcocks and multiple-use flush solutions. Maintenance bundle activities include daily site monitoring, review of needleless connectors, “scrub the hub” 15 seconds connector care, monthly review of CVC-BSIs, and the 2-person, sterile IV tubing change done every 96 hours.