Journal
AMERICAN JOURNAL OF MEDICAL QUALITY
Volume 31, Issue 3, Pages 197-202Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/1062860614568647
Keywords
central line-associated bloodstream infections; intensive care units; quality improvement; hospital-acquired infections
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Funding
- Centers for Medicare and Medicaid Services Partnership for Patients Hospital Engagement Network
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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.
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