PURPOSE: In response to an increase in blood stream infection (BSI) rates greater than national benchmarks in the less than 1 kg infant, a multidisciplinary team was assembled to address the problem. After literature review, epidemiology consultation and practice comparisons with like NICU settings, groups of desired interventions were developed as practice bundles. The immediate goal of the intervention bundle strategy was to standardize practice through identification of best practices and to develop an action plan to eliminate blood stream infection in the NICU.
METHODS: In collaboration with the Performance Improvement (PI) Department, a root cause analysis was performed to identify causes of blood stream infection in this setting. Themes emerged from the literature review on BSI in the NICU population and strategies to combat it. Those themes, IV access and management and hand washing were used to guide bundle formation. Nursing practice bundles (NPB) were then presented to the staff through mandatory educational in-services. Hand washing surveillance was conducted before and after the education. Measures to eliminate some of the barriers to hand washing such as ensuring the availability of soap and/or antimicrobial hand gels at each patient bedside were instituted. Observation tools, looking at hand hygiene and adherence to IV line management bundle guidelines, were utilized quarterly, and the data used to evaluate the bundles and their efficacy.
RESULTS: The NPBs were first implemented as a pilot with an annual evaluation of effectiveness. Under the direction of the epidemiology department weekly surveillance for methicillin resistant Staph aureus, ceftazidime-resistance and vancomycin resistant enterococcus via nasal & rectal swabs was initiated for all NICU patients. Additionally, all patients are cultured on admission, and placed on contact precautions for the first 72 hours. The BSI rate has steadily decreased and has remained below the national benchmarks for the target population for more than 5 consecutive quarters.
CONCLUSIONS: The initial goal to reduce t BSI rates below the national benchmarks has been met. The NPB has become the standard of care with annual review and refinement based on the strongest and most current evidence available.