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

Sean M. Berenholtz MD MHS, Lisa H. Lubomski PhD, Kristina Weeks MHS, Christine A. Goeschel ScD MPA MPS RN, Jill A. Marsteller PhD MPP, Julius C. Pham MD PhD, Melinda D. Sawyer MSN RN CNS-BC, David A. Thompson DNSc MS RN, Bradford D. Winters PhD MD, Sara E. Cosgrove MD MS, Ting Yang PhD MHS, Thomas A. Louis PhD, Barbara Meyer Lucas MD MHSA, Christine T. George MS RN, Sam R. Watson MSA MT(ASCP), Mariana I. Albert-Lesher MS, Justin R. St. Andre MA, John R. Combes MD, Deborah Bohr MPH, Stephen C. Hines PhD, James B. Battles PhD, Peter J. Pronovost MD PhD and On the CUSP: Stop BSI program
Infection Control and Hospital Epidemiology
Vol. 35, No. 1 (January 2014), pp. 56-62
DOI: 10.1086/674384
Stable URL: http://www.jstor.org/stable/10.1086/674384
Page Count: 7
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Eliminating Central Line–Associated Bloodstream Infections: A National Patient Safety Imperative
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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.

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