UCSF’s William H. Tooley Intensive Care Nursery has gone 135 days without a single central line-associated bloodstream infection.
The achievement of this milestone is an example of teamwork and collaboration between the nursing staff, physicians and infection control personnel at UCSF.
Founded in 1964, the Intensive Care Nursery — sometimes referred to as a neonatal intensive care unit (NICU) — was one of the first of its kind in the world. It now cares for more than 1,000 infants each year at UCSF Children’s Hospital.
“The problem with infections is something everyone from the federal government on down in health care is realizing,” says Yao Sun, MD, PhD, a neonatologist and perinatologist and medical director of the William H. Tooley Intensive Care Nursery at UCSF Children’s Hospital. “We’re hoping to join the NICUs with zero infections soon.”
Some NICUs have gone close to two years without bloodstream infections, Sun says. While UCSF is not yet at the forefront of all NICUs in this regard, it is well on its way.
Providing the highest-quality, patient-centered care is a top priority for UCSF, and is included as one of seven strategic directions in the campuswide strategic plan. The UCSF Strategic Plan identifies three goals related to patient care, including providing care that leads to optimal outcomes and patient satisfaction, setting the standard for patient safety, and improving access to care. More information about the UCSF Strategic Plan is posted here.
Dangers of Infection
The NICU at UCSF Children’s Hospital provides care for critically ill newborns, requiring the expertise of staff trained to treat the smallest, sickest and most fragile babies. Infections have multiple, negative effects for these vulnerable infants: They increase the risk for death, chronic lung disease and neurodevelopmental problems, and increase patients’ length of stay.
Most babies in the NICU rely on a catheter to receive nutrients. Central line-associated bloodstream infections are related to the catheter, which enters the baby through a peripheral vein, such as one on the wrist, and then threads up to go into a large central vein, such as the inferior vena cava.
The catheter inserted into a newborn is among the tiniest in existence. It’s about the size of a spaghetti strand, and for years was actually called a spaghetti catheter.
It’s through this catheter that the newborn, premature baby receives glucose, antibiotics, pain drip and vasopressors, among other essentials. For full-term babies, much of the nutrients and necessary antibodies needed for growth comes through the mother, either through breast milk or while the baby was in utero.
However, Michelle Cathcart, RN, manager of the NICU, explains, “For premature babies, a catheter going into the central vein is the only way for them to receive the necessary nutrition essential to grow.”
Best Practices
Studies have shown that the best way to prevent central line-associated bloodstream infections is through hand hygiene — using antibiotic gel before handling a baby or nearby items, such as a monitor.
“The reduction in infection is really due to a change in culture at UCSF,” says Cathcart. “Dr. Yao Sun has been instrumental in creating the cultural shift which supports nurses in their role as gatekeepers.”
In addition to hand hygiene, nurses at UCSF also enforce no wearing of jewelry or long-sleeve shirts in the NICU. These rules apply to anyone touching a baby, including nurses, physicians and family members. UCSF best practices also include the use of chlorhexidine, an antimicrobial agent for cleaning skin, and training a core group of nurses to do dressing changes for central lines.
When a central line-associated bloodstream infection is discovered, the baby is treated with antibiotics. UCSF Infection Control will investigate and determine whether the infection is related to a central line, and then ask nurses and physicians in a nonpunitive way whether there was a breach in correct practices. Findings are then reported in a transparent manner.
UCSF’s approach to treating and preventing infections is communicated to a consortium of 17 California hospitals that are looking into best practices. The consortium comes together through the California Department of Health Services and California Children’s Services. The goal of the consortium is to look at how to decrease hospitalization — decreasing central blood line infections is one major way.
Recently, the UCSF Intensive Care Nursery held a raffle as an incentive to further inspire staff to keep up the good work. On the 100th day with no infections, UCSF held a drawing for a $100 Macy’s gift certificate. ICN nurse Michael Duggan, RN, was the winner.
“The winners are really our patients and their families,” says Cathcart. “The teamwork in stamping out bloodstream infections in the ICN is wonderful. Everyone on the unit works very hard to ensure the very best for our most vulnerable patients.”
