Charge Nurses Taking Charge, Challenging the Culture of Culture-Negative Sepsis, and Preventing Central-Line Infections to Reduce NICU Antibiotic Usage

Samarth Shukla; Josef Cortez; Bill Renfro; Kartikeya Makker; Colleen Timmons; P. Sireesha Nandula; Rita Hazboun; Rima Dababneh; Cristina Hoopes; Jenny VanRavestein; Yvette McCarter; Marilyn Middlebrooks; Ma Ingyinn; Ana Alvarez; Mark L. Hudak

doi:10.1055/s-0040-1719079

American Journal of Perinatology, Table of Contents

Am J Perinatol 2022; 39(08): 861-868
DOI: 10.1055/s-0040-1719079

Original Article

Charge Nurses Taking Charge, Challenging the Culture of Culture-Negative Sepsis, and Preventing Central-Line Infections to Reduce NICU Antibiotic Usage

Samarth Shukla

¹Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida

,

Josef Cortez

¹Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida

,

Bill Renfro

²Department of Pharmacy, University of Florida Health, Jacksonville, Florida

,

Kartikeya Makker

³Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland

,

Colleen Timmons

¹Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida

,

P. Sireesha Nandula

¹Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida

,

Rita Hazboun

⁴Division of Neonatology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia

,

Rima Dababneh

¹Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida

,

Cristina Hoopes

⁵Department of Women's and Children's Nursing Services, University of Florida Health, Jacksonville, Florida

,

Jenny VanRavestein

⁵Department of Women's and Children's Nursing Services, University of Florida Health, Jacksonville, Florida

,

Yvette McCarter

⁶Department of Pathology and Laboratory Medicine, University of Florida Health, Jacksonville, Florida

,

Marilyn Middlebrooks

⁷Department of Infection Prevention and Control, University of Florida Health, Jacksonville, Florida

,

Ma Ingyinn

¹Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida

,

Ana Alvarez

⁸Division of Infectious Diseases and Immunology, University of Florida College of Medicine, Jacksonville, Florida

,

Mark L. Hudak

¹Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida

› Author Affiliations

Abstract

Objective We aimed to reduce our monthly antibiotic usage rate (AUR, days of treatment per 1,000 patient-days) in the neonatal intensive care unit (NICU) from a baseline of 330 (July 2015–April 2016) to 200 by December 2018.

Study Design We identified three key drivers as follows: (1) engaging NICU charge nurses, (2) challenging the culture of culture-negative sepsis, and (3) reducing central-line associated bloodstream infections (CLABSI). Our main outcome was AUR. The percentage of culture-negative sepsis that was treated with antibiotics for >48 hours and CLABSI was our process measure. We used hospital cost/duration of hospitalization and mortality as our balancing measures.

Results After testing several plan-do-study-act (PDSA) cycles, we saw a modest reduction in AUR from 330 in the year 2016 to 297 in the year 2017. However, we did not find a special-cause variation in AUR via statistical process control (SPC) analysis (u'-chart). Thereafter, we focused our efforts to reduce CLABSI in January 2018. As a result, our mean AUR fell to 217 by December 2018. Our continued efforts resulted in a sustained reduction in AUR beyond the goal period. Importantly, cost of hospitalization and mortality did not increase during the improvement period.

Conclusion Our sequential quality improvement (QI) efforts led to a reduction in AUR. We implemented processes to establish a robust antibiotic stewardship program that included antibiotic time-outs led by NICU charge nurses and a focus on preventing CLABSI that were sustained beyond the QI period.

Key Points

This is a quality improvement project to reduce antibiotic usage in NICU.
Charge nurses should take charge to reduce infections in NICU.
Central line infections should be reduced to decrease antibiotic usage.

Keywords

antibiotic usage rate - central-line infection - quality improvement

Full Text

References

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