Cohen Children’s Medical Center is celebrating a major patient safety milestone – the hospital has maintained a zero infection rate for central-line associated blood stream infections (CLABSI) in its 57-bed neonatal intensive care unit (NICU) for more than one year.
Central-line infections are one of the most serious hospital acquired infections that can occur. This blood stream infection is introduced through special long-lasting intravenous (IV) catheters (central line catheters) that deliver nutrition, medications and fluids to infants in the NICU. These catheters are also used in critically ill children and adults. While the Cohen Children’s NICU typically outperforms the national average of 2 CLABSI per 1,000 central line days, it has refined its process to do even more to prevent central-line infections.
“This is a tremendous achievement and I applaud our dedicated staff who work around the clock to make Cohen Children’s NICU a safer environment for our neonates,” said Charles Schleien, MD, senior vice president and executive director pediatric service line at Cohen Children’s Medical Center. “While we celebrate this milestone, our clinical staff is focused on continued diligence to prevent central-line infections in the NICU.”
“Cohen Children’s significant achievement in infection prevention is the result of a multidisciplinary team effort including physicians, nurses, nurse practitioners and infection control staff,” said Joanna Beachy, MD, PhD, medical director of the NICU. “Following evidence-based strategies our clinicians have consistently implemented checklists and audits for compliance with central line entry, maintenance and dressing change protocols.”
According to Dr. Beachy, it is difficult to prevent infections in NICU infants for several reasons:
- Central lines are used to deliver IV nutrition until the infant can tolerate full feeds
- IV lines are frequently accessed to give medications, increasing the risk of infection
- NICU infants are preterm and/or critically ill, leading them to be in a relatively immunocompromised state
In 2017, Cohen Children’s NICU saw a rise in central line infections from MRSA, which is caused by a type of staph bacteria that's resistant to many antibiotics and yielded 1.43 CLABSI’s per 1,000 central line days. With increased emphasis on the collaborative infection prevention initiatives to prevent CLABSI’s already in place in the NICU, along with increased emphasis on hand hygiene for all personnel and visitors, there have been zero CLABSI’s since June 19, 2017. Cohen Children’s NICU has admitted more than 2,100 infants during that span. This translates into zero CLABSI’s per 1,000 central line days.
Medical experts agree that central line infections are preventable with simple checklists, hygienic precautions and sterile practices. Cooperation among physicians and nurses along with the adherence to precautions by visitors is key. “Maintaining zero infections in central lines for more than a year is an incredible accomplishment requiring a huge team effort,” said Deborah Lawrence, RN, the NICU’s nurse manager. “All of our staff – more than 200 clinicians from all shifts – have been educated about preventing central line infections.”
Also key to achieving the zero infection milestone is the NICU’s participation in hospital and state committees focused on reducing central line infections. At Cohen Children’s, neonatologist Robert Koppel, MD, and Donna Baranek, NNP, neonatal nurse practitioner supervisor, are co-chairs of the NICU’s central line committee, which meets twice a month to address clinical issues. Staff members from the NICU participate in the hospital’s monthly hospital advisory for infection management meeting. In addition, the NICU has representatives on the New York State Perinatal Quality Collaborative.
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