Jersey City Medical Center (JCMC) has gone seven years without a central line-associated bloodstream infection (CLABSI) in a neonatal patient, a feat hospital leaders attribute to the NICU’s stringent hygiene and sterilization policies.

The Level III NICU at JCMC treats premature infants and other newborns in need of specialized treatment, along with those born with cardiac or respiratory issues, congenital anomalies, or other complications.

The hospital began to approach CLABSI prevention aggressively seven years ago, says Ameth Aguirre, MD, MPH, FAAP, medical director of NICU and Newborn Services at JCMC.

The rate of CLABSI was too high. Leaders assessed its policies and procedures, including a special look at specifics like the cleaning products used for central lines. The hospital settled on one product, and eliminated others.

The hospital also educated nurses on how to establish, maintain, and remove central lines, while physicians revised the criteria for what patients could receive them. Staff observe stringent protocols for handwashing and sanitization, and the NICU set strict criteria to determine which patients are eligible for central line placement.

“Physicians have standardized guidelines for what babies can receive the central line so we’re not inserting them right and left,” Aguirre says. “We also educated people more on when to remove the lines, which plays a large role in avoiding infections.”

Parents are asked to scrub in for three to five minutes before entering the unit. The challenges came with standardizing the policies and procedures, particularly with determining when a patient should receive a central line. With experienced clinicians coming from different hospitals and training programs, it is normal for there to be some disagreement.

“We get new physicians in from time to time, so we have to make sure that we buy in to our standardized process from those coming in, and also with nurses who are new to the unit,” Aguirre says. “When the nurses are cleaning the hub of the central line, we make sure they are doing it with specific products and they follow the central line change in a specific manner.”

The discontinuation of the line is another important step that must be handled according to the hospital’s protocol. Babies’ central lines are discontinued when they meet specific clinical criteria; if necessary, a peripheral line is placed instead. Teamwork is critical to avoiding CLABSIs. That includes nonclinical staff like environmental services, says Michael Loftus, MD, chief medical officer at JCMC. Those members of the team are included in recognition for the CLABSI streak at the hospital.

“From time to time, we buy pizza, bring food to the NICU, and we are sure to recognize every single person that works with us,” Aguirre says. “Team recognition is very important to provide positive reinforcement that they’re doing the right thing, it’s resulting in measurable improvements in care for our patients, and the hospital sees that they’re successful.”

JCMC is spreading the same concepts and determination to other departments where central lines are used.

“There’s no rocket science to CLABSI prevention. There’s literature out there about the best prevention practices and the recommended steps,” Loftus says. “It’s really just sticking to that bundle each and every time for every single patient, day in and day out. This can be replicated elsewhere, but it takes leadership and a team committed to getting it right every single time, which is easier said than done.”

SOURCES

  • Michael Loftus, MD, Chief Medical Officer, Jersey City (NJ) Medical Center. Phone: (201) 915-2215.
  • Ameth Aguirre, MD, MPH, FAAP, Medical Director, Neonatal Intensive Care Unit, Jersey City (NJ) Medical Center. Phone: (201) 915-2330.