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Several studies demonstrating that central line–associated bloodstream infections (CLABSIs) are preventable prompted a national initiative to reduce the incidence of these infections.
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.
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.
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.
Emotions and emotional feelings arise through the integrated processing of bodily sensations, environmental events, thoughts and recollections, and they shape new learning, facilitate decision-making, and guide behavior. Mood and affect have been defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) according to the durations of the emotions and emotional feelings comprising them. The development of functionally impairing pervasive and sustained disturbances of emotion and emotional feelings suggests a mood disorder such as major depression, dysthymia, mania, hypomania, or cyclothymia. Functionally impairing moment-to-moment disturbances of emotional expression and experience are disorders of affect. This category of clinical conditions includes disorders of affective excess such as pathological laughing and crying, pathological euphoria, essential crying, witzelsucht, and affective lability. The phenomenologies of emotional generation, expression, experience, and control reflect their putative neurobiologies. MacLean applied the principles of evolutionary neurobiology to the description of the limbic system and its function.