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Physicians Update
NICU Goes 15 Months Without Central-Line Infection
The tiny patients of the Neonatal Intensive Care Unit (NICU) typically require IV nutrition to supplement oral feedings. Because of their size and frailty, these infants are generally not well-suited for peripheral IVs over a long period of time; instead, most are given a catheter that is threaded to one of the main vessels that feed the right atrium of the heart. But these more durable central lines also pose greater risks of bloodstream infections from the introduction of pathogens during insertion or from growth from the infant’s skin to the catheter line.
Concern about central-line infections at UCLA Medical Center, Santa Monica’s NICU led to changes that have resulted in the unit going 15 months without an infection. “We felt that our infection rates, although low, were unacceptable, so we brought in the staff to raise awareness and discuss how we needed to change our policies,” says Leticia Dahlke, the NICU’s assistant director.
Assembling best practices from across the country for maintaining the central lines, the unit worked with all staff on implementing the methods through a skills lab and a “buddy” system in which two staff members change the lines together to ensure sterile techniques.
The new approach included “going back to basics” and an emphasis on such things as the importance of hand washing for staff as well as family members and anyone else entering the room, Dahlke says. A new antiseptic solution was introduced to clean the skin. More stringent procedures were instituted to ensure a sterile environment during IV-fluid changes, including maximal barrier precautions (gloves, gowns, masks).
“An infection is a major setback for these babies, and we need to make sure we are doing everything possible to prevent it from occurring,” Dahlke says. Her unit began marking off each day since the last infection occurred — in March 2008 — and the unprecedented span of time without an infection has been a source of pride in the unit.
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