Improvements in our Newborn Special Care Unit
Kapiolani Medical Center for Women and Children is home to the largest Neonatal Special Care Unit (NSCU) in the state of Hawai‘i. In the NSCU we provide intensive care for premature and sick babies who wouldn’t survive without this level of support. Our clinicians are always looking for ways to improve the outcomes for this fragile population. Neonates generally have weak immune systems, with fragile skin barriers, and they often require placement of tubes and catheters which greatly increase their risk for infection. When the NSCU Infection Reduction team began their work, the rate for positive blood cultures was considered better than average compared to national rates. Given that there were other centers in the U.S. demonstrating even lower infection rates, our team set out to improve on our present level of infections.
There are identified practices that can be performed to reduce the chances of a newborn infection while he/she is in the hospital, such as caring for intravenous lines in a certain way or frequently changing tubing. In December, 2005 the clinicians at Kapiolani grouped these practices into a ‘Care Bundle’ and worked to make sure each element of the bundle was systematically carried out for every patient. Care bundles, in general, are groupings of practices that when applied together result in substantially greater improvement than when each practice is applied alone. Care bundles are encouraged by most national organizations including the Institute for Healthcare Improvement (IHI) and the Centers for Disease Control and Prevention (CDC).
The Care Bundle in the Kapiolani NSCU was implemented in December, 2005. The results of these efforts were substantial. Despite an increase in patient load, the NSCU had a decrease in its overall infection rate after the interventions were implemented. The application of the designed Care Bundle in the NSCU resulted in a 58% decrease in positive blood cultures. This decrease has been sustained for over 18 months. The team received international recognition from the IHI when they won first place at the 12th International Scientific Symposium on Improving Quality and Value in Health Care, in Orlando, FL. http://a4hi.org/ The results of this project are presently being reviewed for publication in the British Medical Journal (1).
Mavoori H, Balaraman V, Nikaido M, Pappas T, Nakamura K, Ashton M, Neal CR (2008) Prevention of NSCU nosocomial infections through best practice adoption. BMJ QSHC Manuscripts.
