A line team provided for standardized, consistent central-line maintenance care leading to a significant, sustained decrease in CLABSI in a NICU.

ObjectivesHandoffs are critical points in transitioning care between multidisciplinary teams, yet data regarding intensive care unit (ICU) handoffs in pediatric noncardiac surgical patients are lacking. We hypothesized that standardized handoffs from the pediatric operating room (OR) to the ICU would improve physician presence, communication, and patient care parameters.MethodsThis quality improvement initiative was performed at a tertiary children’s hospital. Stakeholders (anesthesiologists, nurses, intensivists, and surgeons) developed a standardized OR to pediatric and neonatal ICU handoff process based on common goals and outcomes of interest. Baseline data were collected before intervention. Implementation was carried out in 2 phases, phase 1 with a written handoff and Phase 2 with a scripted handoff process. Data collected by trained observers included handoff attendance, distractions, and transfer of essential patient information. As a surrogate for outcomes, patient care parameter data were collected for 6 hours after transfer.ResultsAfter phase 1, surgery and ICU physician attendance increased significantly, distractions decreased, and communication of essential patient data improved. In phase 2 (scripted handoff), attendance continued to rise, distractions remained decreased, and transfer of essential information was still improved compared with baseline. Mean handoff duration did not significantly change throughout the study. Certain patient care parameters (escalation of respiratory support, additional laboratory studies, vasopressor administration, antibiotic administration and timing) remained unchanged compared with baseline. However, the need for resuscitative fluid bolus or blood products significantly decreased after implementation phase 2.ConclusionsStandardized handoffs for pediatric noncardiac surgical patients from the OR to the ICU can improve provider attendance and communication.

BackgroundCentral line-associated bloodstream infections (CLABSIs) are challenging to prevent in the neonatal population due to the long-term necessity of central access for nutrition and medication. Neonates are a population at high risk for CLABSIs, and infections in this group are associated with prolonged hospitalization, greater healthcare costs, and increased mortality. Current bundles for CLABSI prevention include a friction scrub of the catheter hub prior to each use. Real-time audits of correct technique can be challenging. In July of 2018, our team developed a new strategy for auditing scrub technique in an attempt to reduce CLABSI rates.MethodsThis project took place in a NICU with 118 level 4 beds from July 2018 to February 2019. Our NICU is located in a large metropolitan area and serves as a referral center for complex neonates throughout the region. The intervention period encompassed 25,085 patient-days and 6,206 line days. Real-time friction scrub audits were performed for both dedicated line team staff as well as bedside nurses. In order to determine whether a healthcare worker’s (HCW) scrub technique was successful, a colorless luminescent product was applied to a practice catheter hub that adhered to the hub, but was not visible to the HCW. The HCW would then demonstrate a friction scrub on the practice catheter, and the hub was placed under a black light to show where any residual product may be present. This process was repeated until the staff member was able to remove the product from the hub. Once the staff was successful, monthly real-time audits were continued to reinforce the correct technique.ResultsBetween July 2018 and February 2019, compliance with scrub technique and ability to clear product from catheter hubs increased by 50%. The CLABSI rate in the first 9 months after intervention was 0.806 per 1000 line days as compared with 2.170 per 1000 line days in the previous fiscal year.ConclusionThe number of CLABSI’s during the intervention period was 63% less when compared with the previous fiscal year. This process, in conjunction with our other CLABSI prevention practices, has significantly decreased both our CLABSI rate and overall numbers. This project emphasizes the importance of focusing on the basics of infection prevention practices and continual auditing to prevent practice creep.Disclosures All authors: No reported disclosures.

We read with interest the article by Holzmann-Pazgal et al., 1 regarding a significant decrease in central line associated blood stream infection (CLABSI) when they introduced a percutaneously inserted central catheters (PICC) maintenance team, after unsuccessfully attempting to decrease the rate of infection with other methods. We want to point out that 10 years ago, before broad implementation of bundles, public reporting of CLABSI, or the Medicare nonpayment policy on hospital acquired infection, we published in this very journal the same kind of results (Golombek et al. 2). Our study was similarly conducted in a busy neonatal intensive care unit that had a problem with CLABSIs, which was also resistant to asepsis-targeted interventions. Our research similarly concluded that the PICC maintenance team provided 'proactive management which significantly reduced the incidence of catheter-related infections, with a concomitant savings in morbidity and medical expense.' With the introduction of a PICC maintenance team, we were able to reduce the incidence of CLABSI from 25% or 15.8/1000 catheter days to a rate of 7.1% or 5.1/1000 catheter days. We believe that our findings are important to mention alongside this publication. Although providing a better mechanism for standardized central-line care, implementation of a PICC team may also serve to create key stakeholders for CLABSI rates. The positive influence of stakeholder engagement has been demonstrated throughout the health-care system, and is quite possibly an important factor in neonatal CLABSI rates as well.