title: Reduction of central line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement.
abstract: BACKGROUND
  Elimination of hospital-acquired infections is an important patient safety goal.
  
  
  METHODS
  All 174 medical, cardiac, surgical and mixed Veterans Administration (VA) intensive care units (ICUs).
  
  
  METHODS
  A centralised infrastructure (Inpatient Evaluation Center (IPEC)) supported the practice bundle implementation (handwashing, maximal barriers, chlorhexidinegluconate site disinfection, avoidance of femoral catheterisation and timely removal) to reduce central line-associated bloodstream infections (CLABSI). Support included recruiting leadership, benchmarked feedback, learning tools and selective mentoring.
  
  
  METHODS
  Sites recorded the number of CLABSI, line days and audit results of bundle compliance on a secure website.
  
  
  METHODS
  CLABSI rates between years were compared with incidence rate ratios (IRRs) from a Poisson regression and with National Healthcare Safety Network referent rates (standardised infection ratio (SIR)). Pearson's correlation coefficient compared bundle adherence with CLABSI rates. Semi-structured interviews with teams struggling to reduce CLABSI identified common themes.
  
  
  RESULTS
  From 2006 to 2009, CLABSI rates fell (3.8-1.8/1000 line days; p<0.01); as did IRR (2007; 0.83 (95% CI 0.73 to 0.94), 2008; 0.65 (95% CI 0.56 to 0.76), 2009; 0.47 (95% CI 0.40 to 0.55)). Bundle adherence and CLABSI rates showed strong correlation (r = 0.81). VA CLABSI SIR, January to June 2009, was 0.76 (95% CI 0.69 to 0.90), and for all FY2009 0.88 (95% CI 0.80 to 0.97). Struggling sites lacked a functional team, forcing functions and feedback systems.
  
  
  CONCLUSIONS
  Capitalising on a large healthcare system, VA IPEC used strategies applicable to non-federal healthcare systems and communities. Such tactics included measurement through information technology, leadership, learning tools and mentoring.
authors: VA Inpatient Evaluation Center, Cincinnati VAMC, Cincinnati, Ohio 45220, USA. marta.render@va.gov
authors: Marta L
authors: ML
authors: Render
authors: Rachael
authors: R
authors: Hasselbeck
authors: Ron W
authors: RW
authors: Freyberg
authors: Timothy P
authors: TP
authors: Hofer
authors: Anne E
authors: AE
authors: Sales
authors: Peter L
authors: PL
authors: Almenoff
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control*; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000458:organization & administration*; D007318:Inservice Training / Q000458:organization & administration; D007362:Intensive Care Units / Q000458:organization & administration*; D008611:Mentors; D058996:Quality Improvement / Q000458:organization & administration; D018805:Sepsis / Q000517:prevention & control*; D014481:United States; D014493:United States Department of Veterans Affairs