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Eliminating Central Line–Associated Bloodstream Infections: A National Patient Safety Imperative

Published online by Cambridge University Press:  10 May 2016

Sean M. Berenholtz*
Affiliation:
Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Lisa H. Lubomski
Affiliation:
Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Kristina Weeks
Affiliation:
Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Christine A. Goeschel
Affiliation:
Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Jill A. Marsteller
Affiliation:
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Julius C. Pham
Affiliation:
Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Melinda D. Sawyer
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
David A. Thompson
Affiliation:
Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Bradford D. Winters
Affiliation:
Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Sara E. Cosgrove
Affiliation:
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Ting Yang
Affiliation:
Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Thomas A. Louis
Affiliation:
Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Barbara Meyer Lucas
Affiliation:
Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality, Lansing, Michigan
Christine T. George
Affiliation:
Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality, Lansing, Michigan
Sam R. Watson
Affiliation:
Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality, Lansing, Michigan
Mariana I. Albert-Lesher
Affiliation:
Health Research and Educational Trust, Bethesda, Maryland
Justin R. St. Andre
Affiliation:
Health Research and Educational Trust, Bethesda, Maryland
John R. Combes
Affiliation:
Health Research and Educational Trust, Bethesda, Maryland
Deborah Bohr
Affiliation:
Health Research and Educational Trust, Bethesda, Maryland
Stephen C. Hines
Affiliation:
Health Research and Educational Trust, Bethesda, Maryland
James B. Battles
Affiliation:
Agency for Healthcare Research and Quality, Bethesda, Maryland
Peter J. Pronovost
Affiliation:
Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
*
Armstrong Institute for Patent Safety and Quality, Johns Hopkins University, 750 East Pratt Street, 15th Floor, Baltimore, MD 21202 (sberenho@jhmi.edu)

Abstract

Background.

Several studies demonstrating that central line–associated bloodstream infections (CLABSIs) are preventable prompted a national initiative to reduce the incidence of these infections.

Methods.

We conducted a collaborative cohort study to evaluate the impact of the national “On the CUSP: Stop BSI” program on CLABSI rates among participating adult intensive care units (ICUs). The program goal was to achieve a unit-level mean CLABSI rate of less than 1 case per 1,000 catheter-days using standardized definitions from the National Healthcare Safety Network. Multilevel Poisson regression modeling compared infection rates before, during, and up to 18 months after the intervention was implemented.

Results.

A total of 1,071 ICUs from 44 states, the District of Columbia, and Puerto Rico, reporting 27,153 ICU-months and 4,454,324 catheter-days of data, were included in the analysis. The overall mean CLABSI rate significantly decreased from 1.96 cases per 1,000 catheter-days at baseline to 1.15 at 16–18 months after implementation. CLABSI rates decreased during all observation periods compared with baseline, with adjusted incidence rate ratios steadily decreasing to 0.57 (95% confidence intervals, 0.50–0.65) at 16–18 months after implementation.

Conclusion.

Coincident with the implementation of the national “On the CUSP: Stop BSI” program was a significant and sustained decrease in CLABSIs among a large and diverse cohort of ICUs, demonstrating an overall 43% decrease and suggesting the majority of ICUs in the United States can achieve additional reductions in CLABSI rates.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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Footnotes

a.

On the CUSP: Stop BSI program members are listed at the end of the text

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