title: Nursing leadership at the crossroads: evidence-based practice 'Matching Michigan-minimizing catheter related blood stream infections'(*).
abstract: OBJECTIVE
  a highly successful intervention to reduce infections in intensive care units (ICUs) is now being widely replicated and involved significant nursing leadership. The objective of this manuscript is to describe briefly the intervention, and more explicitly the implications for nursing leadership as quality improvement and patient safety become global healthcare priorities.
  
  
  METHODS
  collaborative cohort study in over 100 ICUs in the United States to implement and evaluate interventions to improve patients' safety.
  
  
  METHODS
  conceptual model aimed at improving clinicians' use of five evidence-based recommendations to reduce rates of catheter-related bloodstream infections rates, with measurement and feedback of infection rates.
  
  
  RESULTS
  one hundred and three ICUs contributed 1981 ICU-months of data representing 375,757 catheter-days. The median rate of catheter-related bloodstream infection per 1000 catheter-days decreased from 2.7 infections at baseline to 0 at 3 months after implementation of the study intervention (P ≤ 0·002), and the mean rate per 1000 catheter-days decreased from 7.7 at baseline to 1.4 at 16-18 months of follow-up (P < 0·002). During the sustainability period, the mean bloodstream infection rate did not significantly change from the initial 18 month postimplementation period (-1%, 95% confidence interval -9% to 7%). Eighty seven percent of the original study participants had data available for the sustainability study.
  
  
  CONCLUSIONS
  broad use of this intervention with achievement of similar results could substantially reduce the morbidity and costs associated with catheter-related bloodstream infections.
  
  
  CONCLUSIONS
  the initial Michigan study and the follow-up analysis, that demonstrated sustained improvements, are leading to similar projects in other countries, include the Matching Michigan project in England. Discussing not only the technical components of the program, but also the nursing leadership aspects may assist nurses just embarking on this work.
authors.affiliation: Johns Hopkins School of Medicine Anesthesia and Critical Care Medicine, Associate Faculty; Baltimore, MD 21231, USA. cgoesch1@jhmi.edu
authors.forename: Christine A
authors.initials: CA
authors.lastname: Goeschel
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003422:Critical Care / Q000458:organization & administration*; D004059:Diffusion of Innovation; D004739:England / Q000453:epidemiology; D055317:Evidence-Based Practice / Q000458:organization & administration*; D005500:Follow-Up Studies; D006801:Humans; D017053:Infection Control / Q000458:organization & administration; D007857:Leadership; D008824:Michigan / Q000453:epidemiology; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D058996:Quality Improvement / Q000458:organization & administration; D017751:Safety Management / Q000458:organization & administration; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D057170:Translational Research, Biomedical; D014481:United States / Q000453:epidemiology