Using quality improvement methodology to reduce central line associated blood stream infections - a case study for NNAP

This case study was included in the 2017 National Neonatal Audit Programme annual report to highlight how a neonatal unit has used its results from the National Neonatal Audit Programme as a basis to identify and implement local quality improvement activities. You can download full case study below.

Background

The neonatal unit of the Royal Hospital for Children in Glasgow was formed in 2015 by the merger of the Royal Hospital for Sick Children (Yorkhill) and the Southern General Hospital (SGH) neonatal units on the site of the latter. It consists of 50 beds and provides tertiary level care including surgery, neurosurgery and all neonatal cardiac and ECMO services for Scotland. The unit is part of the West of Scotland Managed Clinical Network and has been contributing to NNAP data since 2015.

What we did: Standardising process

Central line insertion and maintenance bundles were used to standardise processes.

Key elements of insertion included:

  • two person technique
  • use of hat, mask, gown and gloves
  • use of appropriate cleaning solution
  • securing with a standard technique and documentation of line tip position
  • an auditable checklist was developed for the assistant and a sticker developed for documentation. These were used for both umbilical and percutaneous (PICC) catheters. Lines inserted in theatre did not use an insertion checklist.

What we achieved: Sustained improvement

From November 2015 there has been sustained improvement, with 13 consecutive months on or below the baseline median of 9.46. Compliance fell because we (the QI team) measured raw data to obtain a correct measure of compliance rather than the observers interpretation of the compliance question. The new baseline of 3.31 CLABSI per 1000 line days per month represents a 65% reduction in the median.

Work is ongoing to further reduce this rate with the introduction of a new SPSP central line bundle in May 2017.