Table 3. Types of HAI Prevention Activities

Final Report: Executive Summary (continued)

Focus	Activities
Clinical improvements	Standards for line insertion (e.g., checklists, sterile barrier precautions, avoidance of femoral line). Standards for line maintenance (e.g., schedule for dressing changes, "scrub the hub,"* use of chlorhexidine, biopatch, specialized lines/tubing). Routine assessment of line necessity. Adoption of new/better products for infection prevention. Hand-washing initiatives.
Process improvements	Structured improvement processes (e.g., committee structure, root-cause analyses, learning from defects). Use of standardized line carts. Multidisciplinary rounds and safety huddles.
Organizational improvements	Strong leadership at multiple levels. Focus on improving culture (e.g., emphasis on patient safety, transparency, improvement orientation, nurse empowerment). Visible identification of CLABSI prevention as a goal/priority. Widespread communication of CLABSI rates (e.g., posted on units, on screensavers). Rewards and recognition for CLABSI prevention. Empowerment of nurses and other staff to stop procedures if protocols are not followed. Enhanced efforts to monitor and report rates; compliance with protocols.

Key: CLABSI = central line–associated bloodstream infection; HAI = healthcare-associated infection.

* "Scrub the hub" refers to cleaning the hub of a central line prior to use. For examples of materials used to promote this practice, go to http://www.ihi.org/resources/Pages/Tools/ScrubtheHubPosters.aspx.