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NICU Culture Change Lowers Infection Rates

Each year, the neonatal intensive care unit (NICU) at Regional Medical Center in Memphis, Tenn., cares for more than 1,300 babies. To ensure that the infant patients receive the highest quality of care, the hospital launched an initiative to transform its safety culture, which helped staff successfully adopt central line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) best practices. As a result, Regional Medical Center’s NICU has gone more than one year without a VAP case and has celebrated periods of more than 100 days between CLABSIs.

Changing culture is never easy, but according to the NICU nurse manager, education and leadership involvement were key to achieving front-line staff buy-in. For example, the hospital educated staff about potential infections and the importance of handwashing, as well as showed a March of Dimes video about an infection-associated NICU fatality. Meanwhile, hospital leaders sought front-line staff feedback about which practices would best fit into their daily routines, a program element that boosted staff morale and accountability for the project’s outcomes. “Now we look at every hospital-acquired infection (HAI) and do a deep dive to find out how we can do better,” the nurse manager says.

Operating in an enhanced culture of safety, staff felt empowered to implement best practices. Enacting daily shift huddles increased the nurses’ situational awareness, allowing them to foresee possible safety events before they occur.

Specific to CLABSI, staff adopted:

  • two-person sterile line changes;
  • using chloroprep to “scrub the hub;” and
  • a daily needs assessment that requires a physician to explain requests that conflict with standard central line recommendations.

As of August 2013, rates had dropped to three CLABSIs per 1,000 line days. Now staff are working to further prevent central line site contamination and bloodstream infections by exclusively using chlorhexidine for central line maintenance.

To address VAP, the NICU staff began to check for proper head-of-bed elevation every four hours and use biotene gel, which contains antibacterial ingredients for daily oral care. The hospital also retrained staff on certain evidence-based practices, such as suctioning patients’ mouths before inserting the endotracheal tube and maintenance timeframes. Finally, the unit implemented a “closed suction system,” which helps to prevent bacterial buildup, and recruited respiratory therapy to be a part of the team. These interventions have helped Regional Medical Center maintain a zero VAP rate for 17 consecutive months.

According to the NICU nurse manager, Regional Medical Center’s success stems from the staff’s continued engagement in the improvement initiatives, which has led them to set ambitious goals.

Originally published Nov. 9, 2013

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