title: Reducing preventable harm: observations on minimizing bloodstream infections.
abstract: Purpose The purpose of this paper is to provide a practical framework that health care organizations could use to decrease preventable healthcare-acquired harms. Design/methodology/approach An existing theory of how hospitals succeeded in reducing rates of central line-associated bloodstream infections was refined, drawing from the literature and experiences in facilitating improvement efforts in thousands of hospitals in and outside the USA. Findings The following common interventions were implemented by hospitals able to reduce and sustain low infection rates. Hospital and intensive care unit (ICU) leaders demonstrated and vocalized their commitment to the goal of zero preventable harm. Also, leaders created an enabling infrastructure in the way of a coordinating team to support the improvement work to prevent infections. The team of hospital quality improvement and infection prevention staff provided project management, analytics, improvement science support, and expertise on evidence-based infection prevention practices. A third intervention assembled Comprehensive Unit-based Safety Program teams in ICUs to foster local ownership of the improvement work. The coordinating team also linked unit-based safety teams in and across hospital organizations to form clinical communities to share information and disseminate effective solutions. Practical implications This framework is a feasible approach to drive local efforts to reduce bloodstream infections and other preventable healthcare-acquired harms. Originality/value Implementing this framework could decrease the significant morbidity, mortality, and costs associated with preventable harms.
authors.affiliation: Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.|Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA.|Department of Surgery, Johns Hopkins University , Baltimore, Maryland, USA.|Department of Health Policy and Management, Johns Hopkins University , Baltimore, Maryland, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.affiliation: Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.|Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA.
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Weaver
authors.affiliation: Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.|Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA.|Department of Surgery, Johns Hopkins University , Baltimore, Maryland, USA.|Department of Health Policy and Management, Johns Hopkins University , Baltimore, Maryland, USA.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Berenholtz
authors.affiliation: Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.|Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Lubomski
authors.affiliation: Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.|Department of Medicine, Division of Infectious Diseases, Johns Hopkins University , Baltimore, Maryland, USA.
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Maragakis
authors.affiliation: Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.|Department of Health Policy and Management, Johns Hopkins University , Baltimore, Maryland, USA.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Marsteller
authors.affiliation: Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.|Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA.|Queens Medical Center, Honolulu, Hawaii, USA.
authors.forename: Julius Cuong
authors.initials: JC
authors.lastname: Pham
authors.affiliation: Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.
authors.forename: Melinda D
authors.initials: MD
authors.lastname: Sawyer
authors.affiliation: Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.|Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA.|Johns Hopkins School of Nursing, Division of Acute and Chronic Care, Johns Hopkins University , Baltimore, Maryland, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Thompson
authors.affiliation: Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.|Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Weeks
authors.affiliation: Armstrong Institute for Patient Safety and Quality , Johns Hopkins Medicine, Baltimore, Maryland, USA.|Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University , Baltimore, Maryland, USA.|Department of Health Policy and Management, Johns Hopkins University , Baltimore, Maryland, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rosen
mesh_terms: D016470:Bacteremia / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration; D061214:Patient Safety; D058996:Quality Improvement
keywords: Bloodstream infections; Improvement science; Patient safety; Preventable harm; Quality improvement