Quality improvement initiative successful in sustaining reduction in bloodstream infections caused by catheters
A project that significantly reduced catheter-related central line bloodstream infections in Michigan intensive care units (ICUs) over an 18-month period appears to have staying power, according to a new study. In fact, when the initiative was extended for an additional 18 months, participating hospitals found that their infection rates remained very low.
Peter J. Pronovost, M.D., Ph.D., of Johns Hopkins University, and colleagues led the quality improvement initiative for reducing the infection rates by stressing hand washing, using full-barrier precautions (cap, mask, sterile gown, and gloves and sterile drape covering the patient), cleaning the skin with chlorhexidine, avoiding the femoral artery, and removing unnecessary catheters. As a result, average rates of catheter-related bloodstream infections among the 103 ICUs that participated in the initial 18-month intervention declined from 7.7 to 1.3 per 1,000 catheter days. At the end of an 18-month followup period, the 90 ICUs that participated had average rates of 1.1 per 1,000 catheter days, suggesting that the reduction in catheter-related bloodstream infections is indeed sustainable.
The authors note that several factors contributed to successfully sustaining the project's reduced infection rates. Factors included ensuring that team members received feedback on infection data and saw reducing infection rates as a goal not a competition. Keys to hospitals' success in keeping infection rates low also entailed improving the safety culture, believing that these types of infections are preventable, and involving senior leaders who could provide teams with needed resources. This study was funded in part by the Agency for Healthcare Research and Quality (HS14246).
See "Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: Observational study," by Dr. Pronovost, Christine A. Goeschel, R.N., M.P.A., M.P.S., Elizabeth Colantuoni, Ph.D., and others in the February 3, 2010, British Medical Journal 340, pp. c309-c315.
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