Sustaining Reductions in Catheter Related Bloodstream Infections in Michigan Intensive Care Units: Observational Study

Quality and Safety Research Group, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 1909 Thames Street, Baltimore, MD 21231, USA.
BMJ (online) (Impact Factor: 17.45). 02/2010; 340(feb04 1):c309. DOI: 10.1136/bmj.c309
Source: PubMed


To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections. Design Collaborative cohort study to implement and evaluate interventions to improve patients' safety.
Intensive care units predominantly in Michigan, USA.
Conceptual model aimed at improving clinicians' use of five evidence based recommendations to reduce rates of catheter related bloodstream infections rates, with measurement and feedback of infection rates. During the sustainability period, intensive care unit teams were instructed to integrate this intervention into staff orientation, collect monthly data from hospital infection control staff, and report infection rates to appropriate stakeholders.
Quarterly rate of catheter related bloodstream infections per 1000 catheter days during the sustainability period (19-36 months after implementation of the intervention).
Ninety (87%) of the original 103 intensive care units participated, reporting 1532 intensive care unit months of data and 300 310 catheter days during the sustainability period. The mean and median rates of catheter related bloodstream infection decreased from 7.7 and 2.7 (interquartile range 0.6-4.8) at baseline to 1.3 and 0 (0-2.4) at 16-18 months and to 1.1 and 0 (0.0-1.2) at 34-36 months post-implementation. Multilevel regression analysis showed that incidence rate ratios decreased from 0.68 (95% confidence interval 0.53 to 0.88) at 0-3 months to 0.38 (0.26 to 0.56) at 16-18 months and 0.34 (0.24-0.48) at 34-36 months post-implementation. During the sustainability period, the mean bloodstream infection rate did not significantly change from the initial 18 month post-implementation period (-1%, 95% confidence interval -9% to 7%).
The reduced rates of catheter related bloodstream infection achieved in the initial 18 month post-implementation period were sustained for an additional 18 months as participating intensive care units integrated the intervention into practice. Broad use of this intervention with achievement of similar results could substantially reduce the morbidity and costs associated with catheter related bloodstream infections.

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    • "While used in other hazardous industries for decades, checklists have found their way into healthcare given successful efforts in reducing bloodstream infections in the intensive care unit, in reducing surgical morbidity and mortality in diverse global settings, and in re-engineering the hospital discharge process to decrease avoidable rehospitalisations.31–35 More recently, papers have appeared calling for the further exploration of their use in diagnostic work.36 "
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    BMJ quality & safety 05/2013; 22(Suppl 2). DOI:10.1136/bmjqs-2013-001827 · 3.99 Impact Factor
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    • "Ensuring compliance with guidelines is a vast and complex field of research [11-13]. Common to any improvement strategy is the need for measurement; this serves evaluation purposes, measurement can also be the intervention, or a major component of it [14-16]. In a survey on infection control practices in the US, ICUs were only able to reduce heathcare-associated infection rates (including VAP), when they had a written policy, monitored compliance, and achieved a ≥95% compliance to all elements included in the local care bundle [11,17]. "
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