title: CLABSI Conversations: Lessons From Peer-to-Peer Assessments to Reduce Central Line-Associated Bloodstream Infections.
abstract: A national collaborative helped many hospitals dramatically reduce central line-associated bloodstream infections (CLABSIs), but some hospitals struggled to reduce infection rates. This article describes the development of a peer-to-peer assessment process (CLABSI Conversations) and the practical, actionable practices we discovered that helped intensive care unit teams achieve a CLABSI rate of less than 1 infection per 1000 catheter-days for at least 1 year. CLABSI Conversations was designed as a learning-oriented process, in which a team of peers visited hospitals to surface barriers to infection prevention and to share best practices and insights from successful intensive care units. Common practices led to 10 recommendations: executive and board leaders communicate the goal of zero CLABSI throughout the hospital; senior and unit-level leaders hold themselves accountable for CLABSI rates; unit physicians and nurse leaders own the problem; clinical leaders and infection preventionists build infection prevention training and simulation programs; infection preventionists participate in unit-based CLABSI reduction efforts; hospital managers make compliance with best practices easy; clinical leaders standardize the hospital's catheter insertion and maintenance practices and empower nurses to stop any potentially harmful acts; unit leaders and infection preventionists investigate CLABSIs to identify root causes; and unit nurses and staff audit catheter maintenance policies and practices.
authors.affiliation: Departments of Anesthesiology & Critical Care Medicine (Drs Pham, Berenholtz, Lubomski, Rosen, Thompson, Weaver, and Pronovost and Ms Weeks) and Surgery (Drs Berenholtz and Pronovost), Armstrong Institute for Patient Safety and Quality (Mss Demski, Sawyer, and Weeks and Drs Pham, Berenholtz, Lubomski, Rosen, Thompson, Weaver, and Pronovost), Johns Hopkins University School of Medicine, Baltimore, Maryland; MedStar Health, Washington, District of Columbia (Dr Goeschel); and Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital (Ms Trexler), and Johns Hopkins Health System (Mss Demski and Trexler), Baltimore, Maryland.
authors.forename: Julius Cuong
authors.initials: JC
authors.lastname: Pham
authors.forename: Christine A
authors.initials: CA
authors.lastname: Goeschel
authors.forename: Sean M
authors.initials: SM
authors.lastname: Berenholtz
authors.forename: Renee
authors.initials: R
authors.lastname: Demski
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Lubomski
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rosen
authors.forename: Melinda D
authors.initials: MD
authors.lastname: Sawyer
authors.forename: David A
authors.initials: DA
authors.lastname: Thompson
authors.forename: Polly
authors.initials: P
authors.lastname: Trexler
authors.forename: Sallie J
authors.initials: SJ
authors.lastname: Weaver
authors.forename: Kristina R
authors.initials: KR
authors.lastname: Weeks
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control*; D002985:Clinical Protocols; D003142:Communication; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000458:organization & administration*; D007318:Inservice Training / Q000458:organization & administration; D007362:Intensive Care Units / Q000458:organization & administration*; D007857:Leadership; D015397:Program Evaluation