title: Sustained reduction of central line-associated bloodstream infections outside the intensive care unit with a multimodal intervention focusing on central line maintenance.
abstract: BACKGROUND
  Central venous catheter use is common outside the intensive care units (ICUs), but prevention in this setting is not well studied. We initiated surveillance for central line-associated bloodstream infections (CLABSIs) outside the ICU setting and studied the impact of a multimodal intervention on the incidence of CLABSIs across multiple hospitals.
  
  
  METHODS
  This project was constructed as a prospective preintervention-postintervention design. The project comprised 3 phases (preintervention [baseline], intervention, and postintervention) over a 4.5-year period (2008-2012) and was implemented through a collaborative of 37 adult non-ICU wards at 6 hospitals in the Rochester, NY area. The intervention focused on engagement of nursing staff and leadership, nursing education on line care maintenance, competence evaluation, audits of line care, and regular feedback on CLABSI rates. Quarterly rates were compared over time in relation to intervention implementation.
  
  
  RESULTS
  The overall CLABSI rate for all participating units decreased from 2.6/1000 line-days preintervention to 2.1/1,000 line-days during the intervention and to 1.3/1,000 line-days postintervention, a 50% reduction (95% confidence interval, .40-.59) compared with the preintervention period (P .0179).
  
  
  CONCLUSIONS
  A multipronged approach blending both the adaptive and technical aspects of care including front line engagement, education, execution of best practices, and evaluation of both process and outcome measures may provide an effective strategy for reducing CLABSI rates outside the ICU.
authors.affiliation: Department of Medicine, Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY; Center for Community Health, University of Rochester Medical Center, Rochester, NY. Electronic address: Ghinwa_dumyati@urmc.rochester.edu.
authors.forename: Ghinwa
authors.initials: G
authors.lastname: Dumyati
authors.affiliation: Center for Community Health, University of Rochester Medical Center, Rochester, NY.
authors.forename: Cathleen
authors.initials: C
authors.lastname: Concannon
authors.affiliation: Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Edwin
authors.initials: E
authors.lastname: van Wijngaarden
authors.affiliation: Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Tanzy M T
authors.initials: TM
authors.lastname: Love
authors.affiliation: Department of Medicine, Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY.
authors.forename: Paul
authors.initials: P
authors.lastname: Graman
authors.affiliation: Infection Prevention, Highland Hospital, Rochester, NY; Infection Prevention, University of Rochester Medical Center, Rochester, NY.
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Pettis
authors.affiliation: Infection Prevention, Highland Hospital, Rochester, NY.
authors.forename: Linda
authors.initials: L
authors.lastname: Greene
authors.affiliation: Department of Medicine, Infectious Disease Unit, Unity Health System, Rochester, NY.
authors.forename: Nayef
authors.initials: N
authors.lastname: El-Daher
authors.affiliation: Infection Prevention, Unity Health System, Rochester, NY.
authors.forename: Donna
authors.initials: D
authors.lastname: Farnsworth
authors.affiliation: Center for Community Health, University of Rochester Medical Center, Rochester, NY.
authors.forename: Gail
authors.initials: G
authors.lastname: Quinlan
authors.affiliation: Infection Control and Emergency Preparedness, FF Thompson Health System, Canandaigua, NY.
authors.forename: Gloria
authors.initials: G
authors.lastname: Karr
authors.affiliation: Infection Control and Emergency Preparedness, FF Thompson Health System, Canandaigua, NY.
authors.forename: Lynnette
authors.initials: L
authors.lastname: Ward
authors.affiliation: Infection Prevention, Lakeside Hospital, Brockport, NY.
authors.forename: Robin
authors.initials: R
authors.lastname: Knab
authors.affiliation: Department of Medicine, Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY; Department of Medicine, Highland Hospital, Rochester, NY.
authors.forename: Mark
authors.initials: M
authors.lastname: Shelly
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D062905:Central Venous Catheters / Q000382:microbiology*; D004203:Disinfection / Q000379:methods*; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D009518:New York / Q000453:epidemiology; D009736:Nursing Process; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000517:prevention & control*
keywords: Needleless connector; Nursing education; Nursing engagement