Using evidence, rigorous measurement, and collaboration to eliminate central catheter-associated bloodstream infections.

Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD, USA.
Critical care medicine (Impact Factor: 6.15). 08/2010; 38(8 Suppl):S292-8. DOI: 10.1097/CCM.0b013e3181e6a165
Source: PubMed

ABSTRACT Healthcare-associated infections are common, costly, and often lethal. Although there is growing pressure to reduce these infections, one project thus far has unprecedented collaboration among many groups at every level of health care. After this project produced a 66% reduction in central catheter-associated bloodstream infections and a median central catheter-associated bloodstream infection rate of zero across >100 intensive care units in Michigan, the Agency for Healthcare Research and Quality awarded a grant to spread this project to ten additional states. A program, called On the CUSP: Stop BSI, was formulated from the Michigan project, and additional funding from the Agency for Healthcare Research and Quality and private philanthropy has positioned the program for implementation state by state across the United States. Furthermore, the program is being implemented throughout Spain and England and is undergoing pilot testing in several hospitals in Peru. The model in this program balances the tension between being scientifically rigorous and feasible. The three main components of the model include translating evidence into practice at the bedside to prevent central catheter-associated bloodstream infections, improving culture and teamwork, and having a data collection system to monitor central catheter-associated bloodstream infections and other variables. If successful, this program will be the first national quality improvement program in the United States with quantifiable and measurable goals.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Central venous catheter use is common outside the intensive care units (ICUs), but prevention in this setting is not well studied. We initiated surveillance for central line-associated bloodstream infections (CLABSIs) outside the ICU setting and studied the impact of a multimodal intervention on the incidence of CLABSIs across multiple hospitals.
    American Journal of Infection Control 05/2014; · 2.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The economic pressure on German hospitals has increased considerably over the last years, mainly because of the introduction of a flat-rate payment system, and it will most likely further increase under the current demographic and political conditions. The growing dominance of economics in the inpatient sector increases the pressure on hospital staff and results in an increased volume of care (with sometimes inappropriate overtreatment) and uncontrolled rationing and a continuous struggle to maintain the quality of patient care. This development is not only alarming from an ethical perspective, but also impairs the hospital's economic performance. To counter the increasing economic pressure with "more ethics" does - according to the line of reasoning adopted in this article - not appear to be very successful. Rather, central ethical values in inpatient care have to become an integral part of hospital management. This value management first requires a clear definition of the normative standards, e.g. within a mission statement. Second, the realisation of the normative standards in routine inpatient care has to be systematically assessed, evaluated and managed. Since normative standards are difficult to measure objectively and on a quantitative scale, (repeated) surveys among hospital staff are the central instrument to secure the "internal quality" of the hospital. It appears very likely that more ethics in the hospital will pay off by improving its economic performance. The empirical proof for this conceptually extremely plausible hypothesis has yet to be provided.
    Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen. 01/2014; 108(2-3):157-165.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background There is evidence that meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia can be reduced with improved infection control and antibiotic stewardship. Aim To survey infection control and antibiotic stewardship practices within European hospitals and to identify initiatives that correlate with reduced MRSA prevalence. Methods Online questionnaires were sent to European hospitals about their surveillance, hand hygiene, intravenous device management, admission screening, isolation, antibiotic prescribing, hospital demographics and MRSA blood cultures isolates during 2010. Findings In all, 269 replies were received from hospitals in 29 European countries. MRSA prevalence showed significant association with presence of incidence surveillance, performance of root cause analysis, mandatory training requirements for hand hygiene, accountability measures for persistent non-compliance, and multi-stakeholder teamwork in antibiotic prescribing. Presence of policies on intravenous catheter insertion and management showed no variation between different MRSA prevalence groups. However, low-prevalence hospitals reported more competency assessment programmes in insertion and maintenance of peripheral and central venous catheters. Hospitals from the UK and Ireland reported the highest uptake of infection control and antibiotic stewardship practices that were significantly associated with low MRSA prevalence, whereas Southern European hospitals exhibited the lowest. In multiple regression analysis, isolation of high-risk patients, performance of root cause analysis, obligatory training for nurses in hand hygiene, and undertaking joint ward rounds including microbiologists and infectious disease physicians remained significantly associated with lower MRSA prevalence. Conclusion Proactive infection control and antibiotic stewardship initiatives that instilled accountability, ownership, teamwork, and validated competence among healthcare workers were associated with improved MRSA outcomes.
    Journal of Hospital Infection 08/2014; · 2.78 Impact Factor


Available from
Jul 11, 2014