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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

Authors

  • Samarth Shukla

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

  • Josef Cortez

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

  • Bill Renfro

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

  • Kartikeya Makker

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

  • Colleen Timmons

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

  • P. Sireesha Nandula

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

  • Rita Hazboun

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

  • Rima Dababneh

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

  • Cristina Hoopes

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

  • Jenny VanRavestein

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

  • Yvette McCarter

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

  • Marilyn Middlebrooks

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

  • Ma Ingyinn

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

  • Ana Alvarez

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

  • Mark L. Hudak

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

Note

Institutional Review Board at University of Florida Health Jacksonville (UFHJ) approved this initiative as a QI project. Any sensitive health information was not shared or disclosed outside UFHJ.




Publication History

Received: 03 April 2020

Accepted: 24 September 2020

Article published online:
03 November 2020

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