Leadership and reduction of central line infections

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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.

Abstract:

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.

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