title: Eliminating central line-associated bloodstream infections: a national patient safety imperative.
abstract: BACKGROUND
  Several studies demonstrating that central line-associated bloodstream infections (CLABSIs) are preventable prompted a national initiative to reduce the incidence of these infections.
  
  
  METHODS
  We conducted a collaborative cohort study to evaluate the impact of the national "On the CUSP: Stop BSI" program on CLABSI rates among participating adult intensive care units (ICUs). The program goal was to achieve a unit-level mean CLABSI rate of less than 1 case per 1,000 catheter-days using standardized definitions from the National Healthcare Safety Network. Multilevel Poisson regression modeling compared infection rates before, during, and up to 18 months after the intervention was implemented.
  
  
  RESULTS
  A total of 1,071 ICUs from 44 states, the District of Columbia, and Puerto Rico, reporting 27,153 ICU-months and 4,454,324 catheter-days of data, were included in the analysis. The overall mean CLABSI rate significantly decreased from 1.96 cases per 1,000 catheter-days at baseline to 1.15 at 16-18 months after implementation. CLABSI rates decreased during all observation periods compared with baseline, with adjusted incidence rate ratios steadily decreasing to 0.57 (95% confidence intervals, 0.50-0.65) at 16-18 months after implementation.
  
  
  CONCLUSIONS
  Coincident with the implementation of the national "On the CUSP: Stop BSI" program was a significant and sustained decrease in CLABSIs among a large and diverse cohort of ICUs, demonstrating an overall 43% decrease and suggesting the majority of ICUs in the United States can achieve additional reductions in CLABSI rates.
authors: Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Sean M
authors: SM
authors: Berenholtz
authors: Lisa H
authors: LH
authors: Lubomski
authors: Kristina
authors: K
authors: Weeks
authors: Christine A
authors: CA
authors: Goeschel
authors: Jill A
authors: JA
authors: Marsteller
authors: Julius C
authors: JC
authors: Pham
authors: Melinda D
authors: MD
authors: Sawyer
authors: David A
authors: DA
authors: Thompson
authors: Bradford D
authors: BD
authors: Winters
authors: Sara E
authors: SE
authors: Cosgrove
authors: Ting
authors: T
authors: Yang
authors: Thomas A
authors: TA
authors: Louis
authors: Barbara
authors: B
authors: Meyer Lucas
authors: Christine T
authors: CT
authors: George
authors: Sam R
authors: SR
authors: Watson
authors: Mariana I
authors: MI
authors: Albert-Lesher
authors: Justin R
authors: JR
authors: St Andre
authors: John R
authors: JR
authors: Combes
authors: Deborah
authors: D
authors: Bohr
authors: Stephen C
authors: SC
authors: Hines
authors: James B
authors: JB
authors: Battles
authors: Peter J
authors: PJ
authors: Pronovost
mesh_terms: D000328:Adult; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D015397:Program Evaluation; D014481:United States / Q000453:epidemiology