title: Evidence-based practice to reduce central line infections.
abstract: 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.
authors.affiliation: VA Inpatient Evaluation Center, Veterans Affairs Medical Center, Cincinnati, USA. marta.render@med.va.gov
authors.forename: Marta L
authors.initials: ML
authors.lastname: Render
authors.forename: Suzanne
authors.initials: S
authors.lastname: Brungs
authors.forename: Uma
authors.initials: U
authors.lastname: Kotagal
authors.forename: Mary
authors.initials: M
authors.lastname: Nicholson
authors.forename: Patricia
authors.initials: P
authors.lastname: Burns
authors.forename: Deborah
authors.initials: D
authors.lastname: Ellis
authors.forename: Marla
authors.initials: M
authors.lastname: Clifton
authors.forename: Rosie
authors.initials: R
authors.lastname: Fardo
authors.forename: Mark
authors.initials: M
authors.lastname: Scott
authors.forename: Larry
authors.initials: L
authors.lastname: Hirschhorn
mesh_terms: 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