NSICU runner-up for best nursing team in Southeast!

A simple number on an 8.5 x 11 piece of paper doesn’t necessarily mean anything. But for the Neurosurgery Intensive Care Unit (NSICU) at UNC Hospitals, that number meant a great deal. The number, which ultimately grew to more than 450, was tacked on the wall in the NSICU break room and marked the number of days on the unit without a catheter-associated bloodstream infection (CA-BSI). The infection-free streak and the work put in by the NSICU team in the past several years also led to nationwide recognition.

NSICU runner-up for best nursing team in Southeast! click to enlarge Congrats to the team in the NSICU for their award-winning patient care!

In April, Advance for Nurses magazine identified the NSICU as the runner-up for best nursing team in the Southeast region of America (North Carolina, South Carolina, Georgia, Tennessee, Mississippi, and Alabama).

The streak and the recognition come as a result of the incredible teamwork in the unit, says the NSICU’s Nicole Clapp, RN, CNIV. That teamwork was necessary because, in 2008, the NSICU had a higher rate for CA-BSIs than any other ICU in the hospital.

“Knowing the specialized needs of our patients and tendency of our patients to have higher infection rates than most, it would have been very easy to rationalize the high infection rates,” Clapp said. “We decided to take the initiative and tackled the problem head-on.”

The team began by modeling procedures from other ICUs. NSICU staff began posting “Procedure in Progress” signs outside patient rooms during all sterile procedures.

Step two was to create a unit-based task force comprised of three nurses: Rebecca Davis (weekday dayshift), Sheela Sajan (nightshift), and Marc Coulombe (weekend and weekday dayshift). This team, led by NSICU nurse manager Jamila Ezell, recommended standardizing the tubing and dressing changes to the same days each week. Clapp also initiated education sessions with every member of the NSICU.

“This was not a goal that our nurses could meet on their own,” Clapp said. “Everyone here, not just our nurses, is a part of the team, and everyone has a role in making sure we’re able to keep our patients safe and prevent infections,” Clapp said. “We’re a bit unique in the way our Health Unit Coordinators (HUCs) and Certified Surgical Technologists (CSTs) champion our infection control efforts.”

Clapp and Ezell were quick to thank Hospital Epidemiology, Performance Improvement and Patient Safety, and the neurosurgery physician leaders for their help in reducing infection rates. Epidemiology piloted a program using biopatches in the NSICU, and given the success of the program, the biopatches, which are placed directly over the central line insertion site, will soon go housewide.

The procedural changes may seem small, but the results have been remarkable. In 2008, the NSICU reached a high of 4.1 CA-BSIs per 1,000 device days. In 2009, the NSICU average was ZERO infections per 1000 device days! The team went more than 450 total days between infections, setting a record for any ICU at UNC Hospitals.

“It gives us a sense of pride knowing that we met our goal to not only reduce our infection rates but to almost completely eliminate them entirely,” said Ezell.

The streak was broken in early 2010. But the chance to start a new streak and the recognition from Advance provide added incentive as the NSICU prepares to double in size and begin caring for a new subset of neuroscience patients, Clapp said.

“Every day we realize that these are not only numbers and dollars saved, but lives spared in the NSICU,” she said.

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