IDSA Poster: Reduction of Central Line Associated Bloodstream Infection (CLABSI) in a Neonatal Intensive Care Unit with Use of Access Site Disinfection Caps
Alice Pong, MD,Infectious Diseases, Rady Children’s Hospital San Diego
Cindy Salgado, BSN, PHN, MBA, CIC, Infection Control, Rady Children’s Hospital San Diego
Mark Speziale, MD, PhD, Neonatology, Rady Children’s Hospital San Diego
Peggy Grimm, MS, RNC-NIC Neonatology, Rady Children’s Hospital San Diego
Chris Abe, BSN, CIC, Infection Control, Rady Children’s Hospital San Diego

Rady Children’s Hospital San Diego, San Diego, CA

Background:
The Neonatal Intensive Care Unit (NICU) contains one of the most vulnerable populations for CLABSI with extended hospitalizations, necessary central venous access, and prolonged indwelling catheter periods. These vulnerabilities make proper disinfection prior to entry of catheters essential in preventing CLABSI. Access site disinfection caps (ASDCs) are devices designed to reduce contamination of central line valves. In October of 2009 Rady Children’s Hospital began a product evaluation on ASDCs in our NICU.

Methods:
The study is a retrospective review of surveillance data collected through the infection control service. The NICU is a 41 bed, level 3 unit with one of the largest surgical services in California. Implementation of ASDCs started in October 2009. Results were collected over a 12 month period and infection rates were compared to rates in the preceding 12 months. Caps contain a saturated sponge containing 70% isopropyl alcohol. The disinfecting caps were placed on all exposed valves [SmartSite® (Smiths Medical) and MicroCLAVE® (ICU Medical)] associated with central venous catheters. Whenever a port was accessed and exposed, a new cap was placed upon completion of the clinician’s task. Cap compliance was measured by daily documentation by designated nursing staff. CLABSI were determined based on CDC definitions. Blood culture contaminants are defined as common skin contaminants that grow from a single culture with simultaneous and/or repeat blood cultures being negative.

Results:
Compared to the pre-intervention period, during the 12 months the ASDC were in use the CLABSI rate decreased from 0.93 infections per 1000 line days to 0.30 per 1000 line days (68%). The number of blood isolates meeting criteria as contaminants decreased from 3.6 to 2.7 per 1000 line days and the number of CLABSIs due to coagulase negative Staphylococci decreased from 4 of 7 CLABSI the previous year to causing 1 of the two CLABSI during the year of product use.

Conclusion:
The CLABSI rate in the first 12 months of use of ASDC was 0.30 per 1000 line days compared to 0.93 per 1000 line days in the preceding 12 months. This product used in conjunction with other CLABSI prevention measures has potential to help us reach our desired CLABSI rate of zero.

IDSA Link: http://idsa.confex.com/idsa/2011/webprogram/Paper30672.html

Disclosures:
A. Pong, None
C. Salgado, None
M. Speziale, None
P. Grimm, None
C. Abe, None