title: Closing the Translation Gap: Toolkit-based Implementation of Universal Decolonization in Adult Intensive Care Units Reduces Central Line-associated Bloodstream Infections in 95 Community Hospitals.
abstract: Challenges exist in implementing evidence-based strategies, reaching high compliance, and achieving desired outcomes. The rapid adoption of a publicly available toolkit featuring routine universal decolonization of intensive care unit (ICU) patients may affect catheter-related bloodstream infections.
  
  
  
  Implementation of universal decolonization-treatment of all ICU patients with chlorhexidine bathing and nasal mupirocin-used a prerelease version of a publicly available toolkit. Implementation in 136 adult ICUs in 95 acute care hospitals across the United States was supported by planning and deployment tactics coordinated by a central infection prevention team using toolkit resources, along with coaching calls and engagement of key stakeholders. Operational and process measures derived from a common electronic health record system provided real-time feedback about performance. Healthcare-associated central line-associated bloodstream infections (CLABSIs), using National Healthcare Safety Network surveillance definitions and comparing the preimplementation period of January 2011 through December 2012 to the postimplementation period of July 2013 through February 2014, were assessed via a Poisson generalized linear mixed model regression for CLABSI events.
  
  
  
  Implementation of universal decolonization was completed within 6 months. The estimated rate of CLABSI decreased by 23.5% (95% confidence interval, 9.8%-35.1%; P = .001). There was no evidence of a trend over time in either the pre- or postimplementation period. Adjusting for seasonality and number of beds did not materially affect these results.
  
  
  
  Dissemination of universal decolonization of ICU patients was accomplished quickly in a large community health system and was associated with declines in CLABSI consistent with published clinical trial findings.
authors.affiliation: Hospital Corporation of America, Nashville, Tennessee Texas A&M Health Science Center College of Medicine, Houston.
authors.forename: Edward
authors.initials: E
authors.lastname: Septimus
authors.affiliation: Hospital Corporation of America, Nashville, Tennessee.
authors.forename: Jason
authors.initials: J
authors.lastname: Hickok
authors.affiliation: Hospital Corporation of America, Nashville, Tennessee.
authors.forename: Julia
authors.initials: J
authors.lastname: Moody
authors.affiliation: Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors.forename: Ken
authors.initials: K
authors.lastname: Kleinman
authors.affiliation: Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors.forename: Taliser R
authors.initials: TR
authors.lastname: Avery
authors.affiliation: University of California, Irvine Health School of Medicine.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Huang
authors.affiliation: Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
authors.affiliation: Hospital Corporation of America, Nashville, Tennessee.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Perlin
mesh_terms: D000281:Administration, Intranasal; D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control*; D001494:Baths; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage / Q000627:therapeutic use*; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin; D002710:Chlorhexidine
keywords: decolonization; healthcare-associated central line–associated bloodstream infections (CLABSI); learning health system; quality improvement; universal decolonization