Overview

The client introduced his project on central line-associated bloodstream infection (CLABSI). The primary motivator for his project is that his NICU has a high rate of central line infections in infants than the national average. He hoped that drawing attention to this issue and incorporating education could make an improvement and decrease the rate of infections. These central lines are either an umbilical line or a PICC (peripherally-inserted central catheter).

Outcome 1 (part 1): Comparing Pre and Post Infection Frequency

We compared the infection frequency of pre/post data based on how many central lines each infant had. From the graph, we could observe that the infection frequency dropped significantly after receiving the education regardless of the number of lines the infants had.

Even though this bar chart showed a significant drop in infection frequency after receiving the education, this result had limitations since we did not consider the line-days (how long the lines were inserted).

Outcome 1 (part 2): Relationship Between Line Days & Infection Probability

Infection vs Line Days
Estimate Std. Error z value Pr(>|z|)
(Intercept) -1.2557127 0.4703322 -2.669842 0.0075887
Line days 0.0352788 0.0205528 1.716500 0.0860707

To consider line-days’ effect on infection, we fit a binomial regression model (CLABSI + ~ Line days). The p-value of the Line-days variable less than 0.1 (as shown in the table above) suggested a significant relationship between those two variables at the 90% confidence level.

In both pre/post education data, we noticed that the infection probability increased as the infants had central line(s) for a more extended period.

Infants with line(s) for less than 35 days
pre/post Total Number of Infants Total Number of Infections Infection Rate
Pre-Education 42 17 0.4047619
Post-Education 14 0 0.0000000

A significant takeaway from this plot was that we did not have a single infection case after receiving the education when the infants had the line(s) for less than 35 days. Whereas in the pre-education environment, infections were frequently occurring regardless of how many days the lines were inserted. Knowing that about 86% (56/65) of admitted infants had the central line(s) for less than 35 days, reducing the infection rate down to 0% with education seemed like a solid way of decreasing the rate of infections.

Outcome 2 (part 1): Self-Report Survey (Pre)

Q1: How familiar are you with central-line-associated bloodstream infection (CLABSI) care bundles?

Q15: Did you suggest or consider the removal of the catheter once the neonate reaches the goal of ≥120 mL/kg/day of enteral nutrition and/or >2.5 g/kg/day of fat intake and/or if the central line is still needed?

Over 20% of participants answered low familiarity with Q1 and Q15, whereas only less than 5% were unfamiliar with the rest of the questions.

Outcome 2 (part 1): Self-Report Survey (Post)

Only 10% answered low familiarity low familiarity with Q1 and Q15 after the education.

Outcome 2 (part 1): Self-Report Survey (Q18)

Q18: Did you make any changes in your practice as a result of the lecture-discussion and posters on CLABSI prevention?

About 41% (16/39) of participants made some sort of changes in their practice as a result of the lecture-discussion and posters on CLABSI prevention.

Outcome 2 (part 2): Line Insert Survey

Outcome 2 (part 3): Line Maintenance Survey

Outcome 2 (part 4): Hand Hygiene Survey

Outcome 3 (part 1): Increased Knowledge of Nursing Staff

Paired t-test
t df p-value 95% C.I. Mean Difference
9.7849 38 6.226e-12 (1.647229, 2.506617) 2.076923

The paired t-test showed the significant improvement in knowledge quiz score.

It is clear that the knowledge quiz score improved significantly after the education.

Outcome 3 (part 2): Increased Knowledge per question

A total of 39 participants took the client’s 10-question quiz before and after the education. For Q1-9, it was observed that more participants got the questions right after attending the client’s seminar. However, there was a noticeable drop in the number of participants who answered Q10 right after the education.

Outcome 3 (part 3): Knowledge Changes (pre to post) by Staff and Question

Q10: According to Centers for Disease Control and Prevention (CDC) guidelines, how long should you vigorously rub your hands together when performing hand hygiene with soap and water?