Eliminating CLABSI: A National Patient Safety Imperative
Areas for Continued Improvement
Although the results described above indicate that the project is making substantial progress toward achieving its recruitment and CLABSI reduction goals, opportunities for improvement remain. The three most important areas for improvement are:
- Recruitment: With fewer than 20 percent of U.S. hospitals containing an ICU participating in this project, encouraging additional hospitals to be involved in this project remains a priority. Certainly some hospitals have participated in very successful local or regional efforts to reduce CLABSI's and have compelling data demonstrating the success of their efforts. However, most nonparticipating hospitals have not made the changes needed to produce sustainable CLABSI rates near zero. The leadership of the American Hospital Association and many State hospital associations are working with AHRQ, the Centers for Disease Control and Prevention (CDC), and the On the CUSP: Stop BSI national project team to encourage all hospitals to participate in the project.
- Data submission: As reflected in tables 2 and 3, only 80 percent of participating adult ICUs in the first two cohorts have submitted CLABSI rate data in each of the reporting periods. While data submission does not improve CLABSI rates, a failure to continuously monitor CLABSI's and to 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.
- Variability: Although CLABSI rates have dropped significantly in the first two cohorts, substantial variability remains between participating units in these cohorts. For the project to reach its stated goal, more than half the units participating in the project must have zero CLABSI's in any given quarter. At present, this standard has not been achieved, so working to reduce variability between units and States and across measurement periods remains a high priority.
Results reported above are aligned with a very encouraging CDC report on the decline in the number of CLABSI's between 2001 and 2009. That report found a decrease in the ICU CLABSI rate from 3.64 per thousand line days in 2001 to 1.65 per thousand line days in 2009.9 While differences in the methods used to calculate these rates mean that comparisons should be made quite cautiously, it does appear that the On the CUSP: Stop BSI project is both succeeding in recruiting units that have higher CLABSI rates than the national average and in helping these units to decrease their rates well below the national average that CDC reports.
This report is not a comprehensive analysis of every important question related to the On the CUSP: Stop BSI national initiative. 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 hospitals. Better understanding the root causes of CLABSI's 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 CLABSI's 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.
9 Vital Signs: Central Line-Associated Blood Stream Infections-United States, 2001, 2008, and 2009. Morbidity and Mortality Weekly Report. Atlanta, GA: Centers for Disease Control and Prevention; 2011 Mar 1;60. Available at: http://www.cdc.gov/mmwr/pdf/wk/mm60e0301.pdf.