title: Reducing the rate of catheter-associated bloodstream infections in a surgical intensive care unit using the Institute for Healthcare Improvement Central Line Bundle.
abstract: BACKGROUND
  Central line-associated bloodstream infections (CLABSIs) are a significant source of morbidity and mortality. This study sought to determine whether implementation of the Institute for Healthcare Improvement (IHI) Central Line Bundle would reduce the incidence of CLABSIs.
  
  
  METHODS
  The IHI Central Line Bundle was implemented in a surgical intensive care unit. Patient demographics and the rate of CLABSIs per 1,000 catheter days were compared between the pre- and postintervention groups. Contemporaneous infection rates in an adjacent ICU were measured.
  
  
  RESULTS
  Baseline demographics were similar between the pre- and postintervention groups. The rate of CLABSIs per catheter days decreased from 19/3,784 to 3/1,870 after implementation of the IHI Bundle (1.60 vs 5.02 CLABSIs per 1,000 catheter days; rate ratio .32 [.08 to .99, P < .05]). There was no significant change in CLABSIs in the control ICU.
  
  
  CONCLUSIONS
  Implementation of the IHI Central Line Bundle reduced the incidence of CLABSIs in our SICU by 68%, preventing 12 CLABSIs, 2.5 deaths, and saving $198,600 annually.
authors.affiliation: Department of Surgery, University of California, Los Angeles, CA, USA.
authors.forename: Greg D
authors.initials: GD
authors.lastname: Sacks
authors.affiliation: Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Diggs
authors.affiliation: Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Hadjizacharia
authors.affiliation: Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Green
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.affiliation: Department of Surgery, Oregon Health & Science University, Portland, OR, USA; Section of Surgical Critical Care, Portland VA Medical Center, Portland, OR, USA. Electronic address: darren.malinoski@va.gov.
authors.forename: Darren J
authors.initials: DJ
authors.lastname: Malinoski
mesh_terms: D018806:APACHE; D000328:Adult; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000592:standards*; D057189:Checklist; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000191:economics / Q000458:organization & administration*; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration*; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D064872:Patient Care Bundles / Q000191:economics / Q000592:standards*; D011446:Prospective Studies; D058996:Quality Improvement
keywords: Catheter-associated line infections; Central venous catheters; Checklist; Healthcare cost; Infection control; Quality improvement