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Central Line–Associated Bloodstream Infection Reduction and Bundle Compliance in Intensive Care Units: A National Study

  • E. Yoko Furuya (a1) (a2), Andrew W. Dick (a3), Carolyn T. A. Herzig (a4), Monika Pogorzelska-Maziarz (a5), Elaine L. Larson (a4) (a6) and Patricia W. Stone (a4)...



To describe compliance with the central line (CL) insertion bundle overall and with individual bundle elements in US adult intensive care units (ICUs) and to determine the relationship between bundle compliance and central line–associated bloodstream infection (CLABSI) rates.


Cross-sectional study.


National sample of adult ICUs participating in National Healthcare Safety Network (NHSN) surveillance.


Hospitals were surveyed to determine compliance with CL insertion bundle elements in ICUs. Corresponding NHSN ICU CLABSI rates were obtained. Multivariate Poisson regression models were used to assess associations between CL bundle compliance and CLABSI rates, controlling for hospital and ICU characteristics.


A total of 984 adult ICUs in 632 hospitals were included. Most ICUs had CL bundle policies, but only 69% reported excellent compliance (≥95%) with at least 1 element. Lower CLABSI rates were associated with compliance with just 1 element (incidence rate ratio [IRR] 0.77; 95% confidence interval [CI], 0.64–0.92); however, ≥95% compliance with all 5 elements was associated with the greatest reduction (IRR, 0.67; 95% CI, 0.59–0.77). There was no association between CLABSI rates and simply having a written CL bundle policy nor with bundle compliance <75%. Additionally, better-resourced infection prevention departments were associated with lower CLABSI rates.


Our findings demonstrate the impact of transferring infection prevention interventions to the real-world setting. Compliance with the entire bundle was most effective, although excellent compliance with even 1 bundle element was associated with lower CLABSI rates. The variability in compliance across ICUs suggests that, at the national level, there is still room for improvement in CLABSI reduction.

Infect Control Hosp Epidemiol 2016;37:805–810


Corresponding author

Address correspondence to E. Yoko Furuya, MD MS, 622 W 168th St, PH-8W #876, New York, NY 10032 (


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1. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160166.
2. Perencevich, EN, Stone, PW, Wright, SB, et al. Raising standards while watching the bottom line: making a business case for infection control. Infect Control Hosp Epidemiol 2007;28:11211133.
3. National and State Healthcare Associated Infections Progress Report. Centers for Disease Control and Prevention website. Published 2015. Accessed November 10, 2015.
4. Berwick, DM, Calkins, DR, McCannon, CJ, Hackbarth, AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA 2006;295:324327.
5. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:27252732.
6. Render, ML, Hasselbeck, R, Freyberg, RW, et al. Reduction of central line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement. BMJ Qual Saf 2011;20:725732.
7. Hospital National Patient Safety Goals. The Joint Commission website. Published 2015. Accessed November 12, 2015.
8. Furuya, EY, Dick, A, Perencevich, EN, Pogorzelska, M, Goldmann, D, Stone, PW. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS One 2011;6:e15452.
9. Stone, PW, Pogorzelska-Maziarz, M, Herzig, CT, et al. State of infection prevention in US hospitals enrolled in the National Health and Safety Network. Am J Infect Control 2014;42:9499.
10. Resar, R, Griffin, FA, Haraden, C, Nolan, TW. Using Care Bundles to Improve Health Care Quality. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2012.
11. Resar, R, Pronovost, P, Haraden, C, Simmonds, T, Rainey, T, Nolan, T. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. J Qual Patient Saf 2005;31.
12. Bion, J, Richardson, A, Hibbert, P, et al. ‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England. BMJ Qual Saf 2013;22:110123.
13. Koll, BS, Straub, TA, Jalon, HS, Block, R, Heller, KS, Ruiz, RE. The CLABs collaborative: a regionwide effort to improve the quality of care in hospitals. Jt Comm J Qual Patient Saf 2008;34:713723.
14. Marsteller, JA, Sexton, JB, Hsu, YJ, et al. A multicenter, phased, cluster-randomized controlled trial to reduce central line-associated bloodstream infections in intensive care units. Crit Care Med 2012;40:29332939.

Central Line–Associated Bloodstream Infection Reduction and Bundle Compliance in Intensive Care Units: A National Study

  • E. Yoko Furuya (a1) (a2), Andrew W. Dick (a3), Carolyn T. A. Herzig (a4), Monika Pogorzelska-Maziarz (a5), Elaine L. Larson (a4) (a6) and Patricia W. Stone (a4)...


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