Coagulase negative staphylococcal (CoNS) bloodstream infection rates are a common cause of late onset sepsis in the neonatal population. Our unit, which is a 31 bedded tertiary neonatal intensive care, had high CoNS rates as part of its benchmarking activities with the Vermont Oxford Network.
Method A multidisciplinary quality improvement team was established, with the aim of reducing the incidence of central line associated CoNS blood stream infections. The team have examined areas of practice potentially contributing to nosocomial infection. Initiatives undertaken include revision of staff teaching and induction programmes, audits and regular monitoring of practice.
Specific interventions included;
Hand washing training using ultraviolet light and GloGerm® with random peer audit.
Training and audit of the implementation of aseptic non touch technique and personal protective equipment.
Training and audit of parents and grandparents hand washing practices.
Revision of skin cleansing guidelines to introduce a more concentrated alcohol based chlorhexidine solution.
Revision of feeding guidelines expediting full enteral feeds by 1–3 days facilitating earlier removal of central lines.
Introduction of a high impact intervention tool on blood culture technique.
Conclusion Through a multidisciplinary quality improvement team, the culture within NICU that nosocomial infection is acceptable or inevitable has been challenged, and a reduction in infection rates has been achieved. This is difficult to consistently maintain and all staff must remain motivated and enthusiastic to ensure improvements continue.
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