This month, Marta Castro, Nurse Researcher at the Centre for Clinical Nursing Science at Zurich University Hospital, Switzerland, is reviewing:
Bedwell S, Oberlechner M, Pogribna U, et al. Using the Expertise of a Clinical Nurse Specialist to Lead a Neonatal Peripherally Inserted Central Catheter Team to Central Line–Associated Bloodstream Infection Reduction and Cost-Efficiency Through Quality Improvement. J Nurs Adm Individ. 2024;54(10):574-579.
Why is this important?
Central Line-Associated Bloodstream Infection (CLABSI) significantly increase morbidity, length of hospital stay and healthcare costs in neonates, particularly in high-acuity Neonatal Intensive Care Units (NICUs). Preventing these infections is critical for patient safety and resource efficiency. Each neonatal CLABSI can cost over $90,000 and add more than a month to hospitalisation. This initiative demonstrates how nurse-led, evidence-based quality improvement can drive sustainable change in infection prevention and reinforces the importance of empowering specialised nursing roles.
What was done in this study?
The clinical nurse specialist (CNS) transitioned peripherally inserted central catheter (PICC) line responsibilities from general bedside staff to a dedicated team of specially trained nurses. This team was responsible for insertion, maintenance and troubleshooting of PICC lines. In-house training programs, led by the CNS, standardised procedures based on national guidelines. Monthly quality meetings were held to review data, identify practice gaps and adjust protocols using Plan-Do-Study-Act cycles. The team also focused on staff education, evidence dissemination and proactive changes to reduce infection risks and promote consistency.
What did the study find?
The study found that implementing a CNS-led PICC team significantly reduced and sustained near-zero CLABSI rates in a large NICU. From an initial rate of 2.2 infections per 1,000 line-days in 2009, the rate dropped to 0 and has remained close to zero for over nine years, with only one infection reported since June 2022. These findings support the effectiveness of dedicated, nurse-led quality improvement models and underscore the importance of specialised roles like the CNS in achieving long-term patient safety goals. The initiative resulted in an estimated $31 million in cost savings due to infection prevention.
Does this apply to my unit?
If your unit uses central lines, especially in a high-acuity neonatal or paediatric setting, this model is highly applicable. The success of the initiative depends on dedicated staff, CNS leadership and organisational support. Units that struggle with consistent central line practices, have high infection rates, or lack standardised training could benefit significantly from adopting a similar approach. Smaller or lower-acuity units may face staffing challenges, but adapting key elements – like standardising insertion protocols, offering regular PICC education and conducting regular case reviews – can still yield improvements. This model demonstrates that even complex systems can sustainably improve outcomes with the right leadership and structure.