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Areas for Continued Improvement

Eliminating CLABSI: A National Patient Safety Imperative--Second Progress Report

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:

  1. 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.
  2. 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.
  3. 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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Conclusion

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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AHRQ Publication No: 11-0037-1-EF

Current as of September 2011
Internet Citation: Areas for Continued Improvement: Eliminating CLABSI: A National Patient Safety Imperative--Second Progress Report. September 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/cusp/using-cusp-prevention/clabsi-update/conclusionj.html