Evidence-based practice to reduce central line infections.
BACKGROUND
In 2003, through the Greater Cincinnati Health Council nine health care systems agreed to participate and fund 50% of a two-year project to reduce hospital-acquired infections among patients in intensive care units (ICU) and following surgery (SIP).


METHODS
Hospitals were randomized to either the CR-BSI or SIP project in the first year, adding the alternative project in year 2. Project leaders, often the infection control professionals, implemented evidence-based practices to reduce catheter-related blood stream infections (CR-BSIs; maximal sterile barriers, chlorhexidine) at their hospitals using a collaborative approach. Team leaders entered process information in a secure deidentifled Web-based database.


RESULTS
Of the four initial sites randomized to CR-BSI reduction, all reduced central line infections by 50% (CR-BSI, 1.7 to 0.4/1000 line days, p < .05). At the project midpoint (3 quarters of 2004), adherence to evidence-based practices increased from 30% to nearly 95%.


CONCLUSIONS
The direct role of hospital leadership and development of a local community of practice, facilitated cooperation of physicians, problem solving, and success. Use of forcing functions (removal of betadine in kits, creation of an accessory pack and a checklist for line insertion) improved reliability. The appropriate floor for central line infections in ICUs is < 1 infection /1,000 line days.
Render
Marta L
ML
VA Inpatient Evaluation Center, Veterans Affairs Medical Center, Cincinnati, USA. marta.render@med.va.gov
Brungs
Suzanne
S
Kotagal
Uma
U
Nicholson
Mary
M
Burns
Patricia
P
Ellis
Deborah
D
Clifton
Marla
M
Fardo
Rosie
R
Scott
Mark
M
Hirschhorn
Larry
L
D001363:Awards and Prizes; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D009096:Multi-Institutional Systems; D009820:Ohio; D011785:Quality Assurance, Health Care