Kristina R Weeks1, Yea-Jen Hsu2, Ting Yang3, Melinda Sawyer4, Jill A Marsteller2. 1. Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: kweeks2@Jhmi.edu. 2. Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 3. Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD. 4. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Abstract
BACKGROUND: Removing unnecessary central lines is a critical step in reducing risk of infection and was 1 focus of a national quality improvement collaborative. We examined if participating adult intensive care units (ICUs) reduced central line days during the project period compared with the period before implementation of the "On the CUSP: Stop BSI" program. METHODS: We used a linear regression model on a total of 9,225 ICU-quarters of data to examine the effect of the intervention on total central line days of ICU participants in the national project (2008-2012), adjusting for ICU type, hospital characteristics, project cohort, season, and accounting for repeated measures on the same unit and clustering within states using random intercepts. RESULTS: The regression results showed no significant change in preintervention quarters. However, significant decreases in total line days started during quarter 4 after intervention and differences were sustained through quarter 6. There were 4% fewer central line catheter days reported at the project's conclusion compared with the baseline. CONCLUSIONS: To keep central lines from doing patients harm, clinicians must assess the need for lines and remove them as soon as clinically advisable to halt the possibility of infection via the line. Effective communication and empowering providers to identify unnecessarily extended use of central lines could accelerate the realization, someday, of eliminating central line associated bloodstream infections in ICUs.
BACKGROUND: Removing unnecessary central lines is a critical step in reducing risk of infection and was 1 focus of a national quality improvement collaborative. We examined if participating adult intensive care units (ICUs) reduced central line days during the project period compared with the period before implementation of the "On the CUSP: Stop BSI" program. METHODS: We used a linear regression model on a total of 9,225 ICU-quarters of data to examine the effect of the intervention on total central line days of ICU participants in the national project (2008-2012), adjusting for ICU type, hospital characteristics, project cohort, season, and accounting for repeated measures on the same unit and clustering within states using random intercepts. RESULTS: The regression results showed no significant change in preintervention quarters. However, significant decreases in total line days started during quarter 4 after intervention and differences were sustained through quarter 6. There were 4% fewer central line catheter days reported at the project's conclusion compared with the baseline. CONCLUSIONS: To keep central lines from doing patients harm, clinicians must assess the need for lines and remove them as soon as clinically advisable to halt the possibility of infection via the line. Effective communication and empowering providers to identify unnecessarily extended use of central lines could accelerate the realization, someday, of eliminating central line associated bloodstream infections in ICUs.
Keywords:
CLABSI bundle; Central line denominator; Central line denominator days; Central line-associated bloodstream infections; Central venous catheters; Comprehensive Unit-based Safety Program; Guidelines
Authors: David J Murphy; Peter F Lyu; Sara R Gregg; Greg S Martin; Jason M Hockenberry; Craig M Coopersmith; Michael Sterling; Timothy G Buchman; Jonathan Sevransky Journal: Crit Care Med Date: 2016-01 Impact factor: 7.598