title: Use of a Central Catheter Maintenance Bundle in Long-Term Acute Care Hospitals.
abstract: OBJECTIVE
  Evidence-based guidelines have resulted in decreases in bloodstream infections associated with central catheters (CLABSIs) in hospital intensive care units. However, relatively little is known about CLABSI incidence and prevention in long-term acute care hospitals (LTACHs).
  
  
  METHODS
  A central catheter maintenance bundle was implemented in 30 LTACHs, and compliance with the bundle was tracked for 6 months. CLABSI rates were monitored for 14 months before and 14 months after the bundle was implemented.
  
  
  RESULTS
  The pooled mean CLABSI rate (No. of infections per 1000 days with a central catheter) was 1.28 before the bundle and 0.96 after the bundle (repeated measures general linear model; F1,58 = 6.973; P = .01; partial η(2) = .11). From 14 months before to 14 months after the bundle was implemented, the mean number of CLABSIs per LTACH decreased by 4.5 (95% CI, 1.85-7.15). Time series modeling showed a significant decrease in the mean hospital CLABSI rate after the bundle was implemented (-0.511 CLABSI/1000 catheter days, SE = 0.050), indicating an immediate effect of the bundle. The mean hospital CLABSI rate was decreasing slightly before the bundle was implemented and continued to decrease at a reduced rate after the bundle was implemented.
  
  
  CONCLUSIONS
  The bundle resulted in a significant and sustained reduction in CLABSI rates in 30 LTACHs for 14 months. These results encourage the development and implementation of similar bundles as effective strategies for infection reduction in LTACHs.
authors.affiliation: Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC. agrigonis@selectmedical.com.
authors.forename: Antony M
authors.initials: AM
authors.lastname: Grigonis
authors.affiliation: Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Dawson
authors.affiliation: Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC.
authors.forename: Mary
authors.initials: M
authors.lastname: Burkett
authors.affiliation: Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC.
authors.forename: Arthur
authors.initials: A
authors.lastname: Dylag
authors.affiliation: Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC.
authors.forename: Matthew
authors.initials: M
authors.lastname: Sears
authors.affiliation: Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC.
authors.forename: Betty
authors.initials: B
authors.lastname: Helber
authors.affiliation: Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Snyder
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000379:methods*; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000295:instrumentation / Q000379:methods*; D007362:Intensive Care Units; D008134:Long-Term Care / Q000379:methods; D017410:Practice Guidelines as Topic