title: Impact of self-reported guideline compliance: Bloodstream infection prevention in a national collaborative.
abstract: BACKGROUND
  We sought to examine self-reported compliance with 5 evidence-based central line-associated bloodstream infection (CLABSI) prevention practices and link compliance to CLABSI rates in a national patient safety collaborative.
  
  
  METHODS
  We analyzed data from a national CLABSI prevention program. Adult ICUs participating in the program submitted their CLABSI rates and a Team Checkup Tool (TCT) on a monthly basis. The TCT responses provided self-reported perceptions about how reliably the unit team performed the evidence-based practices in the previous month. Monthly data were aggregated into quarters for the analysis. We analyzed a total of 2775 ICU quarters during the program.
  
  
  RESULTS
  Chlorhexidine skin preparation and hand hygiene had the highest adherence. Avoidance of the femoral site and removal of unnecessary lines had the lowest compliance. Regression results showed that consistent performance of all practices was significantly associated with lower CLABSI rates. In terms of each practice's independent effect, femoral site avoidance for line placement and removal of unnecessary lines were independently associated with lower CLABSI rates after controlling for other factors.
  
  
  CONCLUSIONS
  Our findings suggest that uptake of the 2 low-compliance practices, avoidance of the femoral site and removal of unnecessary lines, is important for reducing CLABSI rates in conjunction with other practices.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Yea-Jen
authors.initials: YJ
authors.lastname: Hsu
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Kristina
authors.initials: K
authors.lastname: Weeks
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Ting
authors.initials: T
authors.lastname: Yang
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Melinda D
authors.initials: MD
authors.lastname: Sawyer
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: jmarste2@jhu.edu.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Marsteller
mesh_terms: D061605:Administration, Intravenous / Q000009:adverse effects; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000379:methods*; D002710:Chlorhexidine; D003428:Cross Infection / Q000517:prevention & control; D019983:Guideline Adherence; D063373:Hand Hygiene; D006287:Health Planning Guidelines; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D061214:Patient Safety; D010818:Practice Patterns, Physicians'; D057566:Self Report
chemical_list: D002710:Chlorhexidine
keywords: Central line–associated bloodstream infections; Guidelines; Hospital-acquired infection; Intensive care unit