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Abstract
Context Matching Michigan (MM) was initiated by the National Patient Safety Agency (NPSA). It is a care bundle focusing on reducing healthcare – associated infections and has been implemented in 97% of adult and Paediatric ICUs across the NHS since 2011. Neonatal infection is an important cause of morbidity, mortality and prolonged hospital stay, particularly those born pre-term and of very low birthweight (VLBW)
Problem We looked the levels of catheter-associated (CVC-BSI) Coagulase Negative Staphylococcus (CONS) infections in a busy Level 3 NICU.
Assessment of problem and analysis of its causes We quantified the rate of CVC-BSI per 1000 catheter days and performed root-cause analysis (RCA) to identify the source of these infections.
Intervention We fully implemented Matching Michigan to assess the effects on CONS infection rates. Technical (Check list, line trolley, hand hygiene, longline pack, removal of catheter when not required) and non-technical (RCA, feedback, clinical and executive partnerships, data collection and reporting) interventions were employed.
Study design Retrospective, observational analyses, as well as a prospective, interventional, non-randomised approach were used. The primary outcome was a reduction in CVC-BSI, identified through CONS positive blood and line tip cultures using set criteria.
Strategy for change CVC-BSI rates for 3 months prior to intervention were noted. A previous ‘partial’ implementation of MM in 2012, had produced no significant difference. The current intervention included aseptic non-touch technique (ANTT) education and specific ‘line insertion’ teaching at induction for medical staff, use of special ‘longline pack’, and mandatory implementation of MM checklist. Root cause analysis provided simultaneous feedback and ability to highlight areas of potential concern.
Measurement of improvement CVC-BSI rates were measured for 7months following intervention, monitoring CONS positive blood and line tip cultures against ‘catheter days’. The data showed an infection rate pre-intervention of 9.13 CVC-BSI per 1000 line days, compared to 3.42 CVC-BSI per 1000 post-intervention (Figure 1).
Number of CVC-BSI per 1000 line days pre and post intervention
Effects of changes The intervention appears to have reduced the measured CVC-BSI rate, reducing patient morbidity, complications of treatment and potentially duration of stay. This study also highlighted the need for ongoing training, vigilance and feedback to maintain this decreased level.
Lessons learnt This study demonstrated a measurable decrease in infection rates associated with full implementation of Matching Michigan principles. On further review, we could not however, identify one sole part of the intervention that brought about this change.
Message for others A relatively cost-effective and straightforward intervention, combined with support from senior team members, appears to have produced a dramatic reduction in CVC-BSI rates, which could be reproducible in ICU/NICUs in other hospitals.