• Article
  • March 15, 2018

How 3 Children's Hospitals are Eliminating Errors, Infections in the NICU

Here are three initiatives making big patient-safety strides in children's hospital NICUs around the country—initiatives you can replicate to protect some of your hospital's most vulnerable patients and drive down errors and infections in your institution.

3,464 central line days without a CLABSI

Behind a consistent, coordinated effort to prevent these infections, the Pediatric Intensive Care Unit on the St. Paul campus of Children's Hospitals and Clinics of Minnesota achieved a major patient-safety milestone: it went nearly three years without a central line-associated bloodstream infection (CLABSI)—3,464 central line days in total.

A hospital-wide campaign, Journey to Zero, stressed preventing harm—moving as closely as possible to zero harm to patients—as the primary goal for staff. Steps toward this goal are continuously measured, monitored, communicated and celebrated. They include:

  • A hand-washing campaign, which raised hand hygiene rates above 90 percent
  • Empowering staff at all levels to speak up when they spot a potentially harmful situation
  • Early adoption of daily chlorohexidine baths
  • Daily patient assessments to remove central lines whenever possible

Read more about CLABSI prevention at Children's Minnesota.

Driving a 64 percent decrease in CLABSI rates

A quality improvement initiative conducted by the Standardizing Line care Under Guideline recommendations (SLUG Bug) collaborative—a partnership of more than a dozen children's hospitals aimed at reducing preventable bloodstream infections in neonatal patients—has shown substantial declines in CLABSIs.

Notably, hospitals that transitioned to a sterile tubing change (TC) technique in which sterile gloves and a mask were used with a sterile barrier under the central venous catheter, reported a 64 percent decrease in CLABSI rates.

Though the transition to the TC technique has shown impressive results, collaborative leaders stress the importance of a culture shift to effect widespread improvements in infection rates. "There's not one magic bullet to lowering infections—it's the culture of infection prevention that is important," says Eugenia Pallotto, M.D., M.S.C.E, the medical director of the NICU at Children's Mercy Kansas City and a co-author of the SLUG Bug TC technique study published in Pediatrics.

"Centers have to look at all the different possibilities and highlight practices that could be additive at their site—it's a combination of a lot of things."

Read more about the SLUG Bug collaborative.

Virtually eliminating breast milk administration errors

When Children's Hospital of Orange County (CHOC) experienced three breast milk administration errors and 16 near-misses over a two-year span, it became clear that change was needed. Christine Bixby, M.D., medical director of lactation services and a neonatology specialist at CHOC, and her team spent most of 2012 analyzing the entire breast milk administration process and identified 282 potential failure points.

Primary among them: inadequate double checks at key points in the breast milk administration process that could lead to mis-administration. To address this issue, CHOC decided to centralize its breast milk administration process.

In January 2013, CHOC moved the management of breast milk administration from the individual patients' nurses to a nutrition lab staffed by two registered dietetic technicians (DTRs.) The DTRs were responsible for preparing breast milk for all patients, ensuring label accuracy and freshness of the milk.

But this process was manual and subject to a degree of human error. So, in November 2013, the hospital implemented bar code scanning into the breast milk administration process. Each baby has a tag with a unique bar code matching the breast milk labels. DTRs scan the labels and tags prior to feeding to ensure accuracy. As a result, breast milk administration errors at CHOC have been virtually eliminated.

Read more about how CHOC is reducing breast milk administration errors.

Send questions or comments to magazine@childrenshospitals.org.