CLABSI reduction using evidence based interventions and nurse empowerment: A quality improvement initiative from a tertiary care NICU in Pakistan

Authors

Ali Shabbir Hussain, Aga Khan UniversityFollow
Anjum Mohyuddin Ahmed, Aga Khan University
Saba Arbab, Aga Khan University
Shabina Ariff, Aga Khan UniversityFollow
Syed Rehan Ali, Aga Khan UniversityFollow
Simon Demas, Aga Khan UniversityFollow
Jehan Zeb, Aga Khan UniversityFollow
Arjumand Rizvi, Aga Khan UniversityFollow
Ali Faisal Saleem Dr, Aga Khan University,Follow
Joveria Farooqi, Aga Khan UniversityFollow

Document Type

Article

Department

Paediatrics and Child Health; Pathology and Laboratory Medicine

Abstract

Objective: Central line associated bloodstream infection (CLABSI) is an important cause of morbidity and mortality in the neonatal intensive care unit (NICU). We designed a CLABSI Prevention Package (CPP) to decrease NICU CLABSI rates, using evidence-proven interventions.
Design: This was a quality improvement (QI) project. Data collection was divided into three phases (pre-implementation, implementation and post implementation). SQUIRE2.0 guidelines were used to design, implement and report this QI initiative.
Setting: A tertiary care level 3 NICU at the Aga Khan University Hospital (AKUH), Karachi, Pakistan.
Patients: All patients admitted to the AKUH NICU from 1 January 2016 to 31 March 2018 who had a central line in place during their NICU admission.
Interventions: CPP used evidence-based interventions focusing on hand hygiene, aseptic central line insertion techniques and central line care, prevention of fungal infections and nurse empowerment.
Main Outcome Measures: CLABSI rates pre and post intervention were recorded. Secondary outcomes were risk factors for CLABSI, device (central line) utilisation ratio, CLABSI related mortality and micro-organism profile.
Results: CLABSI rates decreased from 17.1/1000 device days to 5.0/1000 device days (relative risk (RR)=0.36, CI=0.17-0.74). Device (central line) utilisation ratio declined from 0.30 to 0.25. Out of 613 patients enrolled in our study, 139 (22.7%) died. Mortality was higher in CLABSI group (n=20, 44%) as compared with non CLABSI group (n=119, 21.1%) (pConclusions: CPP was effective in decreasing NICU CLABSI rates and can be used as a model to decrease NICU CLABSI rates in low or middle-income countries.

Comments

Volume, issue, and pagination are not provided by the author/publisher

Publication (Name of Journal)

Archives of Disease in Childhood

Recommended Citation

Hussain, A. S., Ahmed, A. M., Arbab, S., Ariff, S., Ali, S. R., Demas, S., Zeb, J., Rizvi, A., Saleem, A., Farooqi, J. (2020). CLABSI reduction using evidence based interventions and nurse empowerment: A quality improvement initiative from a tertiary care NICU in Pakistan. Archives of Disease in Childhood.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatr/839