National Patient Safety Awareness Week

The staff at Monroe Carell Jr. Childrens Hospital at Vanderbilt are striving to eliminate CLABSI in the Neonatal Intensive Care Unit. The initiative started with the creation of a central line change toolkit and change in protocol. The staff in the NICU use a sterile tubing line change kit that includes chlorhexidine pads, alcohol pads, gauze and a drape/towel. Staff members add sterile connectors and other items needed for the central line. This items are placed on a clean table(set aside for line change only). One nurse will be assigned the "clean" nurse and the other will be the "sterile" nurse. Both nurses wear masks before beginning the line change. The clean nurse primes the fluids while the sterile nurse prepares the sterile field. The clean nurse attaches the tubing to the sterile connector and attaches the extra flushes to the connectors while the sterile nurse holds the connector. The clean nurse then cleans the central line site and the sterile nurse connects the connector to the central line site. Another initiative in the NICU is our handwashing policy. Upon entering a room (most patients have private rooms), everyone must wash/foam hands. Scrub up to elbows, removing jewelry. Another process to eliminate CLABSI, is that anyone that enters a room where a sterile line procedure is taking place must wear a mask and if that person is in the area of the sterile field, the person must also wear gown and hat in addition to the mask. All of these efforts have showed an improvement in VCH NICU CLABSI rates. Reports starting 1/13/2009 show 2 days between infection. The best rate we had to date is 87 days between infections. Our current rate is 77 days.

Christina Hillin, RN
Monroe Carell Childrens Hospital at Vanderbilt
NICU
TN