When it comes to central line-associated bloodstream infection (CLABSIs) in the neonatal intensive care unit (NICU), the motto at St. Luke’s Baptist Hospital in San Antonio, Texas, is “Zero is Possible.” And the first step to achieving zero CLABSIs is simple: Believe that you can.
In May, the 36-bed, Level IV NICU at St. Luke’s celebrated 10 years without a CLABSI. A major complication, a CLABSI can increase a baby’s length of stay from seven to 21 days and increase associated costs by $5,000 to $20,000, according to Christine Aune, M.D., neonatologist at Pediatrix® Medical Group of Texas - San Antonio and medical director of the NICU.
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“For babies, infections are literally life-threatening,” said Dr. Aune. “Decreasing infections ensures that babies have the safest NICU stays possible. But it takes attention to detail and a change in mindset; you have to believe that zero is possible — and your team has to be committed to getting there.”
It’s fitting, then, that this year’s theme for International Infection Prevention Week is “Make Your Intention Infection Prevention,” since that’s what the team at St. Luke’s has done for more than a decade.
Collaborating to prevent CLABSIs
Practicing for 10 years without a CLABSI required a multidisciplinary approach, a shared vision and all-hands-on-deck dedication.
Leading the way with Dr. Aune was St. Luke’s nursing director Cynthia McNinch, RN, and neonatal nurse practitioner Gillian Gonzaba, NP, who helped institute central-line bundles — a set of evidence-based practices designed to prevent infections. In addition, Michael Battista, M.D., medical director of Pediatrix Medical Group of Texas - San Antonio, encouraged and supported the practice of excellence.
“It all starts with how your leaders support you, and ours are committed to ensuring we have the resources and research we need to take the best care of our patients,” said Dr. Aune.
Since 2011, the team in St. Luke’s NICU has worked diligently to prevent CLABSIs with a multi-faceted team approach that includes:
- Establishing central-line bundles and checklists that monitor the process of central-line insertion and maintenance.
- Developing a documentation protocol to ensure line integrity and necessity.
- Developing policies requiring two nurses for central-line fluid management.
- Educating all team members — physicians, nurse practitioners, nurses, therapists, and respiratory therapists — about the importance of central-line management.
- Increasing the use of breast milk in the NICU, since babies who are fed breast milk have a lower incidence of hospital-acquired infection (to facilitate this, the team started a donor breast milk program in 2013).
“This is an incredible accomplishment for our team and the culmination of years of hard work,” said Dr. Aune.
Looking toward the future, Dr. Aune said, “There’s no such thing as the status quo in health care. If you’re not actively seeking ways to improve every day, your patients won’t get better. We’re always striving to do better.”
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