Leadership and reduction of central line infections


Intravenous literature: Render, M.L., Hasselbeck, R., Freyberg, R.W., Hofer, T.P., Sales, A.E. and Almenoff, P.L. (2011) Reduction of central line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement. BMJ Quality & Safety. 20, p.725-732.


Background – Elimination of hospital-acquired infections is an important patient safety goal.

Setting – All 174 medical, cardiac, surgical and mixed Veterans Administration (VA) intensive care units (ICUs).

Intervention – A centralised infrastructure (Inpatient Evaluation Center (IPEC)) supported the practice bundle implementation (handwashing, maximal barriers, chlorhexidinegluconate site disinfection, avoidance of femoral catheterisation and timely removal) to reduce central line-associated bloodstream infections (CLABSI). Support included recruiting leadership, benchmarked feedback, learning tools and selective mentoring.

Data collection – Sites recorded the number of CLABSI, line days and audit results of bundle compliance on a secure website.

Analysis – CLABSI rates between years were compared with incidence rate ratios (IRRs) from a Poisson regression and with National Healthcare Safety Network referent rates (standardised infection ratio (SIR)). Pearson’s correlation coefficient compared bundle adherence with CLABSI rates. Semi-structured interviews with teams struggling to reduce CLABSI identified common themes.

Results – From 2006 to 2009, CLABSI rates fell (3.8–1.8/1000 line days; p

Conclusion – Capitalising on a large healthcare system, VA IPEC used strategies applicable to non-federal healthcare systems and communities. Such tactics included measurement through information technology, leadership, learning tools and mentoring.

Main page


Comments are closed.

Free Email Updates
Join 5.5K IVTEAM members. Subscribe now and be the first to receive all the latest free updates from IVTEAM!
100% Privacy. We don't spam.