Hawaii's experience shows that a national collaborative effort can reduce central line-associated bloodstream infections
Central lines are catheters inserted into a vein and guided up into the heart where they deposit a medication, such as antibiotics, for infections and other conditions. Sometimes, these lines can become infected. The resulting bloodstream infections (BSI) may be quite severe and cause death. Preventing these infections is vitally important. Recently, intensive care units across the United States have joined in a collaborative effort to reduce central line-associated bloodstream infections by implementing a safety and intervention program. One study details its success in Hawaii, where infection rates declined considerably.
The national intervention is called "On the CUSP (Comprehensive Unit-Based Safety Program): Stop BSI." It is implemented as a State-level collaborative structured around State hospital associations. In the intensive care unit (ICU), the intervention reminds providers to wash their hands, use chlorhexidine and full barrier precautions, and avoid using the femoral site when placing the line or cleaning it. Caregivers are also encouraged to ask every day if the line can be removed. A second level of the intervention focuses on educating staff, identifying defects, and working as a team. Ultimately, the goal is to achieve a statewide mean BSI rate of less than 1 infection per 1,000 catheter days.
The Hawaii experience included 20 ICUs at 16 hospitals and 61,665 catheter days. Prior to the intervention, the overall mean BSI rate was 1.5 infections per 1,000 catheter days. Following the intervention at 16 to 18 months, this dropped to 0.6. This represented a 61 percent decline. Several lessons were learned from the Hawaii experience. First, implementing this intervention involves more than just using a checklist. Second, communication among hospitals must be effective and time-sensitive. Leaders are also important, as is recognizing those who are doing the work. The study was supported in part by the Agency for Healthcare Research and Quality (Contract No. 290-06-0022).
See "Eradicating central line-associated bloodstream infections statewide: The Hawaii experience," by Della M. Lin, M.D., M.S., Kristina Weeks, M.H.S., Laura Bauer, M.P.H., and others in the September 14, 2011, American Journal of Medical Quality [Epub ahead of print].
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