Download Poster - Creighton University

Routine Chlorhexidine Bathing to Prevent
Central Line Infections in a Level IV NICU
Crista Latimer, BSN, RN, RNC-NIC, NNP Intern, Chelsey Phalen, BSN, RN, RNC-NIC, NNP Intern
Creighton University College of Nursing
The Plan-Do-Check-Act (PDCA) process was used with this performance
improvement project.
Goals
 Staff education
 Educate staff on the importance of eliminating CLABSI in the NICU.
 Improve staff knowledge on how to correctly use the CHG bathing wipes.
 Staff Compliance
 Perform routine baths with CHG bathing wipes every Monday, Wednesday
and Friday on eligible infants with 100% compliance rate.
 All eligible infants with a central line will receive routine CHG baths.
 Eliminate/decrease CLABSI in the NICU
 The occurrence of central line-associated bloodstream infections
documented will be zero or significantly decrease in the NICU.
 There will be no adverse skin reactions documented with proper use of the
CHG bathing wipes.
October
Graph 1
Graph 2
2.5
2
2013
1.5
1
2014
0.5
0
Overall
< 750
750-1000
1001-1500
1501-2500
>2500
Number of CLABSI
Performance Improvement Model
 Overall CLABSI rate was decreased by 28.6% when comparing October-December 2013 to OctoberDecember 2014
 No evidence of skin breakdown was reported by the nursing staff as evidence by documentation of skin
scores.
 Staff compliance with completing and documenting the routine CHG bathing was >90% when assessed
weekly by the primary investigator.
 After 3 months into the study, staff compliance of knowing that chlorhexidine is a topical antiseptic that
has broad activity against Gram-positive and Gram-negative bacteria, yeast and some viruses increased
from 85% to 93%.
 After 3 months, now only 4% thought that it must still be rinsed off the patient after use, compared with
the 57% before.
Number of CLABSI
 Central line-associated bloodstream infection (CLABSI) rates remain a
morbidity and mortality issue in neonatal intensive care units (NICU).
 CLABSIs can result in 11% neonatal mortality and life-long adverse
neurodevelopmental morbidity, such as risk for cerebral palsy,
developmental delay and lower IQ, and is recognized as a preventable,
unfavorable event.
 Infants who obtain such infections are spending more time on mechanical
ventilation, have an increased length of hospital stay, increased health care
costs and a mortality rate that is significantly higher than those who remain
free of infection during their hospital course.
 The performance improvement project team for this
research study was formed consisting of the unit director,
chief neonatologist, infectious disease physician and
physician assistant, infection control physician, clinical
educator, and nurse practitioner interns.
 We researched evidenced-based practice for routine CHG
baths on CLABSI rates in the NICU population and made
recommendations for a performance improvement project.
 All infants > 28 weeks gestation and all infants at least
14 days old if < 28 weeks gestation with an indwelling
central catheter were routinely cleansed with CHG
bathing wipes.
 Routine baths took place every Monday, Wednesday, and
Friday.
 Documentation of the baths was charted by the nursing
staff in the facility’s computer system.
 Daily skin assessments were documented by the nursing
staff using either the Neonatal Skin Risk Assessment
Scale (NSRAS) or the Braden Q skin assessment scale
according to the infant’s gestational age.
 Weekly reports on CHG bathing and compliance were
assessed by the primary investigator on the study.
 We educated staff and implemented a new trial of
practice into routine bathing care, central line care and
unit culture.
 We measured outcomes as ongoing support and education
to maintain practice standards were provided.
 Data reports were assessed at 90 days, and will continue
to be assessed at 180 days, 270 days and 365 days.
 Reported data was compared with data collected in 2013
regarding total number overall and per month of CLABSI
rate, device days and rate of infections per 1,000
central line device days
Outcomes
November
6
5
2013
4
3
2
2014
1
0
Overall
< 750
750-1000
1001-1500
1501-2500
> 2500
Weight in grams
Weight in grams
December
Graph 3
2.5
Number of CLABSI
Background/Problem
Omaha, NE
Methods
2013
2
1.5
2014
1
0.5
0
Overall
< 750
750-1000 1001-1500 1501-2500
> 2500
Weight in grams
Implications for Practice
 As the NICU population continues to get more fragile and delicate, routine CHG bathing can help NICUs
get closer to a goal of “getting to zero” central line infections.
 When maintaining a focus on our patient’s overall health risks when an indwelling central catheter is
present, utilizing evidence-based practice is key to meeting these needs and eliminating CLABSI’s in the
NICU.
Poster developed April 2015