Collaborative cohort study evaluates the impact of the national “On the CUSP: Stop BSI” program

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#IVTEAM #Intravenous literature: Berenholtz, S.M., Lubomski, L.H., Weeks, K., Goeschel, C.A., Marsteller, J.A., Pham, J.C., Sawyer, M.D., Thompson, D.A., Winters, B.D., Cosgrove, S.E., Yang, T., Louis, T.A., Lucas, B.M., George, C.T., Watson, S.R., Albert-Lesher, M.I., St. Andre, J.R., Combes, J.R., Bohr, D., Hines, S.C., Battles, J.B. and Pronovost, P.J. (2014) Eliminating Central Line–Associated Bloodstream Infections: A National Patient Safety Imperative. Infection Control and Hospital Epidemiology. 35(1), p.56-62.

Abstract:

Background: Several studies demonstrating that central line–associated bloodstream infections (CLABSIs) are preventable prompted a national initiative to reduce the incidence of these infections.

Methods: We conducted a collaborative cohort study to evaluate the impact of the national “On the CUSP: Stop BSI” program on CLABSI rates among participating adult intensive care units (ICUs). The program goal was to achieve a unit-level mean CLABSI rate of less than 1 case per 1,000 catheter-days using standardized definitions from the National Healthcare Safety Network. Multilevel Poisson regression modeling compared infection rates before, during, and up to 18 months after the intervention was implemented.

Results: A total of 1,071 ICUs from 44 states, the District of Columbia, and Puerto Rico, reporting 27,153 ICU-months and 4,454,324 catheter-days of data, were included in the analysis. The overall mean CLABSI rate significantly decreased from 1.96 cases per 1,000 catheter-days at baseline to 1.15 at 16–18 months after implementation. CLABSI rates decreased during all observation periods compared with baseline, with adjusted incidence rate ratios steadily decreasing to 0.57 (95% confidence intervals, 0.50–0.65) at 16–18 months after implementation.

Conclusion: Coincident with the implementation of the national “On the CUSP: Stop BSI” program was a significant and sustained decrease in CLABSIs among a large and diverse cohort of ICUs, demonstrating an overall 43% decrease and suggesting the majority of ICUs in the United States can achieve additional reductions in CLABSI rates.

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