Areas for Continued Improvement
Although the results described above
indicate that the project is making substantial progress toward achieving its
recruitment and central line-associated bloodstream infection (CLABSI) reduction goals, opportunities for improvement remain.
The three most important areas for improvement are:
- Targeted interventions for high-rate
units: A substantial majority of participating units report CLABSI rates of zero
in any given project quarter. A relatively small percentage of units with
CLABSI rates over 5 per 1,000 central line days are the primary reason that the
average CLABSI rate remains above 1.0. In the last 6 months, the national
project team has been identifying these facilities, encouraging the State
hospital associations to discuss their rates with them, and developing
resources to support the needs of these units. The success of these efforts to
target high CLABSI rate units will have a significant impact on the ability of
the project to meet its overall goals.
- Data submission: Not all of the
units have submitted CLABSI rate data in each of the reporting periods. While
data submission does not improve CLABSI rates, a failure to continuously
monitor CLABSIs and use each infection to identify processes that must be
improved to prevent them in the future will not lead to sustained improvement.
The national leadership of the project is working closely with the lead
organizations in every participating State to encourage all participating
hospitals to remain fully engaged in the project for its duration and in the
monitoring and reporting of their CLABSI rates.
- Sustainability: While the rates of
participating units have dropped substantially during the first year of
participation in the project, sustaining the reduced rates and driving them
even lower over time requires a sustainable intervention at both the hospital
and the State levels. The Health Research and Educational Trust (HRET) is developing strategies for the State lead
organizations to sustain the improvements that have been made and to extend
them to other units in participating hospitals as well as other hospitals that
chose not to participate in the initial project.
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The national project team continues
to conduct analyses to better understand which units are succeeding, which are
struggling, and why, so that changes may be made to the initiative to maximize
its impact for every participating hospital. Better understanding the root
causes of CLABSIs that continue to occur sporadically in even high-performing
units may also lead to important insights. Continuing to help hospitals
correctly count central line days and identify CLABSIs is vital to efforts to
prevent them and to increase public confidence that this risk to patient safety
is being reduced or even eliminated. While much of the work on this national
initiative still remains, the results in this report indicate that significant
progress is being made toward achieving its goals.
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Publication No: 11-0037-1-EF
Current as of September 2011
Eliminating CLABSI: A National Patient Safety Imperative. Second Progress Report on the National On the CUSP: Stop BSI Project. AHRQ Publication No: 11-0037-1-EF, September 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/clabsiupdate/