title: The CLABs collaborative: a regionwide effort to improve the quality of care in hospitals.
abstract: BACKGROUND
  Each year, nearly 250,000 cases of central line-associated bloodstream infections (CLABs) occur in hospitals in the United States. In 2005, the Greater New York Hospital Association and the United Hospital Fund launched a collaborative initiative to eliminate CLABs in hospital intensive care units (ICUs). COLLABORATIVE DESIGN: Hospital leadership at 36 hospitals committed to support their staffs' participation in specific activities, including three learning sessions. An infectious disease physician consultant served as an on-call consultant to provide the necessary clinical guidance, real-time feedback, and support. Most hospitals' interdisciplinary CLABs teams met weekly to implement evidence-based practices known collectively as the central line bundle, determine areas for additional focus, and to reassess strategies using the Plan-Do-Study-Act (PDSA) model.
  
  
  RESULTS
  There was a statistically significant decrease of 54% (p < .001) between the mean CLABs rate during the intervention period (2.24 infections per 1,000 central line days) compared with the mean baseline rate (4.85 infections per 1,000 central line days). By March 2008, the rate had dropped by 70% (1.44 infections per 1,000 central line days) compared with baseline. At the hospital level, decreases in CLABs rates up to 88% were observed between the baseline period and the intervention period, with 56% of hospitals achieving at least a 50% decrease in their CLABs rate. The hospitals beginning above the national rate decreased their CLABs rates by almost twice as much as hospitals that began below the national average.
  
  
  CONCLUSIONS
  Each participating hospital sustained implementation of the central line bundle throughout the 33-month intervention, which, along with standardized line maintenance procedures, resulted in reduction in, and sometimes elimination of, CLABs.
authors.affiliation: Beth Israel Medical Center, New York City, NY, USA. bkoll@chpnet.org
authors.forename: Brian S
authors.initials: BS
authors.lastname: Koll
authors.forename: Terri A
authors.initials: TA
authors.lastname: Straub
authors.forename: Hillary S
authors.initials: HS
authors.lastname: Jalon
authors.forename: Rachel
authors.initials: R
authors.lastname: Block
authors.forename: Karen S
authors.initials: KS
authors.lastname: Heller
authors.forename: Rafael E
authors.initials: RE
authors.lastname: Ruiz
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006739:Hospital Administration; D006801:Humans; D015994:Incidence; D033183:Interdisciplinary Communication; D007857:Leadership; D010348:Patient Care Team / Q000458:organization & administration; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D013192:Staff Development / Q000458:organization & administration