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Abstract
Aims To reduce the number of Staphyloccous aureus bacteremia in the neonatal unit.
In 2008–9 there were seven Meticillin resistant Staphylococcus aureus (MRSA) bacteremias on the neonatal unit (NNU). A number of interventions were put into place which has eradicated MRSA bacteremia to date, however the incidence of Meticillin sensitive Staphylococcus aureus (MSSA) bacteremia remained unchanged (Figure 1). The aim of this quality improvement project was to reduce MSSA bacteremia.
Staphylococcal bacteremias on NNU
Methods A multi-displinary team (MDT) was formed. The MDT reviewed the current literature for evidence based interventions for managing vascular access. A Care Bundle for vascular access of neonatal patients was developed and implemented on NNU in October 2014. Implementation was through education sessions and poster display with the staff that attain vascular access on NNU (doctors and advanced neonatal practioners (ANNPs)). After six months, a more collaborative approach with nursing staff was initiated by changes to handover, education and communication.
Results The Care Bundle (Figure 2) was developed and displayed around the NNU along with education to the junior doctors and ANNPs. As the consistent shop-floor members of staff, the ANNPs were the
Vascular access care bundle diagram
Bacteremias fell in the first 6 months but another drive on implementation, involving nursing staff has reinforced the care bundle with a sustained reduction in MSSA bacteremia (Figure 3).
Number of MSSA Bacteremias on NNU, May 2012–October 2015
Conclusions A series of evidenced based interventions were effective at eliminating MRSA bacteremias from NNU. However, the incidence of MSSA bacteremia remained problematic. Literature review enabled development of a care bundle to bring together different aspects of good practice. Implementation with the healthcare professionals that attain vascular access showed some improvement. However, when nursing staff were fully engaged, a multi-disciplinary collaborative approach to vascular access and line care has improved with a sustained reduction in MSSA bacteremia rates.
A collaborative, multi-disciplinary, multi-pronged approach to reducing healthcare associated infection rates can be successful.