title: Sustaining Reductions in Central Line-Associated Bloodstream Infections in Michigan Intensive Care Units: A 10-Year Analysis.
abstract: This article describes the interventions that sustained low central line-associated bloodstream infection (CLABSI) rates in the Michigan Keystone ICU Project. This analysis included data from March 2004 to December 2013 for 121 intensive care units (ICUs) in 73 hospitals. The Keystone Project was a cohort collaborative with an improvement team in each ICU. During the sustainability period, teams integrated the intervention into staff orientation, collected and submitted monthly data, and reported infection rates to leaders. The annual mean rate of BSIs dropped from 2.5 infections/1000 catheter-days in 2004 to 0.76 in 2013. A subset analysis found nearly double the percentage of ICUs with a mean rate of <1 infection/1000 catheter-days in 2013 compared with baseline. Active involvement of hospital leaders and the Keystone Center as well as ongoing monitoring and feedback of performance were important in sustaining results. These findings suggest that large-scale improvement projects can be sustained, establishing a new normal for care.
authors.affiliation: Johns Hopkins Medicine, Baltimore, MD Johns Hopkins University School of Medicine, Baltimore, MD ppronovo@jhmi.edu.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.affiliation: Michigan Health and Hospital Association Keystone Center, Lansing, MI.
authors.forename: Sam R
authors.initials: SR
authors.lastname: Watson
authors.affiliation: Johns Hopkins Medicine, Baltimore, MD Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Goeschel
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hyzy
authors.affiliation: Johns Hopkins Medicine, Baltimore, MD Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Berenholtz
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000706:statistics & numerical data; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008824:Michigan / Q000453:epidemiology
keywords: central line–associated bloodstream infections; hospital-acquired infections; intensive care units; quality improvement