Use of Implementation Science for a Sustained Reduction of Central-Line–Associated Bloodstream Infections in a High-Volume, Regional Burn Unit

Geetika Sood, Julie Caffrey, Kelly Krout, Zeina Khouri-Stevens, Kevin Gerold, Stefan Riedel, Janet McIntyre, Lisa Maragakis, Renee Blanding, Jonathan Mark Zenilman, Richard G Bennett, Peter Pronovost

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: We describe the use of implementation science at the unit level and organizational level to guide an intervention to reduce central-line–associated bloodstream infections (CLABSIs) in a high-volume, regional, burn intensive care unit (BICU). DESIGN: A single center observational quasi-experimental study. SETTING: A regional BICU in Maryland serving 300–400 burn patients annually. INTERVENTIONS: In 2011, an organizational-level and unit-level intervention was implemented to reduce the rates of CLABSI in a high-risk patient population in the BICU. At the organization level, leaders declared a goal of zero infections, created an infrastructure to support improvement efforts by creating a coordinating team, and engaged bedside staff. Performance data were transparently shared. At the unit level, the Comprehensive Unit-based Safety Program (CUSP)/ Translating Research Into Practice (TRIP) model was used. A series of interventions were implemented: development of new blood culture procurement criteria, implementation of chlorhexidine bathing and chlorhexidine dressings, use of alcohol impregnated caps, routine performance of root-cause analysis with executive engagement, and routine central venous catheter changes. RESULTS: The use of an implementation science framework to guide multiple interventions resulted in the reduction of CLABSI rates from 15.5 per 1,000 central-line days to zero with a sustained rate of zero CLABSIs over 3 years (rate difference, 15.5; 95% confidence interval, 8.54–22.48). CONCLUSIONS: CLABSIs in high-risk units may be preventable with the a use a structured organizational and unit-level paradigm. Infect Control Hosp Epidemiol 2017;1–6

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalInfection Control and Hospital Epidemiology
DOIs
StateAccepted/In press - Sep 13 2017

Fingerprint

Burn Units
Infection
Intensive Care Units
Chlorhexidine
Root Cause Analysis
Central Venous Catheters
Bandages
Alcohols
Confidence Intervals
Safety
Research
Population

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

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title = "Use of Implementation Science for a Sustained Reduction of Central-Line–Associated Bloodstream Infections in a High-Volume, Regional Burn Unit",
abstract = "OBJECTIVE: We describe the use of implementation science at the unit level and organizational level to guide an intervention to reduce central-line–associated bloodstream infections (CLABSIs) in a high-volume, regional, burn intensive care unit (BICU). DESIGN: A single center observational quasi-experimental study. SETTING: A regional BICU in Maryland serving 300–400 burn patients annually. INTERVENTIONS: In 2011, an organizational-level and unit-level intervention was implemented to reduce the rates of CLABSI in a high-risk patient population in the BICU. At the organization level, leaders declared a goal of zero infections, created an infrastructure to support improvement efforts by creating a coordinating team, and engaged bedside staff. Performance data were transparently shared. At the unit level, the Comprehensive Unit-based Safety Program (CUSP)/ Translating Research Into Practice (TRIP) model was used. A series of interventions were implemented: development of new blood culture procurement criteria, implementation of chlorhexidine bathing and chlorhexidine dressings, use of alcohol impregnated caps, routine performance of root-cause analysis with executive engagement, and routine central venous catheter changes. RESULTS: The use of an implementation science framework to guide multiple interventions resulted in the reduction of CLABSI rates from 15.5 per 1,000 central-line days to zero with a sustained rate of zero CLABSIs over 3 years (rate difference, 15.5; 95{\%} confidence interval, 8.54–22.48). CONCLUSIONS: CLABSIs in high-risk units may be preventable with the a use a structured organizational and unit-level paradigm. Infect Control Hosp Epidemiol 2017;1–6",
author = "Geetika Sood and Julie Caffrey and Kelly Krout and Zeina Khouri-Stevens and Kevin Gerold and Stefan Riedel and Janet McIntyre and Lisa Maragakis and Renee Blanding and Zenilman, {Jonathan Mark} and Bennett, {Richard G} and Peter Pronovost",
year = "2017",
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doi = "10.1017/ice.2017.191",
language = "English (US)",
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T1 - Use of Implementation Science for a Sustained Reduction of Central-Line–Associated Bloodstream Infections in a High-Volume, Regional Burn Unit

AU - Sood, Geetika

AU - Caffrey, Julie

AU - Krout, Kelly

AU - Khouri-Stevens, Zeina

AU - Gerold, Kevin

AU - Riedel, Stefan

AU - McIntyre, Janet

AU - Maragakis, Lisa

AU - Blanding, Renee

AU - Zenilman, Jonathan Mark

AU - Bennett, Richard G

AU - Pronovost, Peter

PY - 2017/9/13

Y1 - 2017/9/13

N2 - OBJECTIVE: We describe the use of implementation science at the unit level and organizational level to guide an intervention to reduce central-line–associated bloodstream infections (CLABSIs) in a high-volume, regional, burn intensive care unit (BICU). DESIGN: A single center observational quasi-experimental study. SETTING: A regional BICU in Maryland serving 300–400 burn patients annually. INTERVENTIONS: In 2011, an organizational-level and unit-level intervention was implemented to reduce the rates of CLABSI in a high-risk patient population in the BICU. At the organization level, leaders declared a goal of zero infections, created an infrastructure to support improvement efforts by creating a coordinating team, and engaged bedside staff. Performance data were transparently shared. At the unit level, the Comprehensive Unit-based Safety Program (CUSP)/ Translating Research Into Practice (TRIP) model was used. A series of interventions were implemented: development of new blood culture procurement criteria, implementation of chlorhexidine bathing and chlorhexidine dressings, use of alcohol impregnated caps, routine performance of root-cause analysis with executive engagement, and routine central venous catheter changes. RESULTS: The use of an implementation science framework to guide multiple interventions resulted in the reduction of CLABSI rates from 15.5 per 1,000 central-line days to zero with a sustained rate of zero CLABSIs over 3 years (rate difference, 15.5; 95% confidence interval, 8.54–22.48). CONCLUSIONS: CLABSIs in high-risk units may be preventable with the a use a structured organizational and unit-level paradigm. Infect Control Hosp Epidemiol 2017;1–6

AB - OBJECTIVE: We describe the use of implementation science at the unit level and organizational level to guide an intervention to reduce central-line–associated bloodstream infections (CLABSIs) in a high-volume, regional, burn intensive care unit (BICU). DESIGN: A single center observational quasi-experimental study. SETTING: A regional BICU in Maryland serving 300–400 burn patients annually. INTERVENTIONS: In 2011, an organizational-level and unit-level intervention was implemented to reduce the rates of CLABSI in a high-risk patient population in the BICU. At the organization level, leaders declared a goal of zero infections, created an infrastructure to support improvement efforts by creating a coordinating team, and engaged bedside staff. Performance data were transparently shared. At the unit level, the Comprehensive Unit-based Safety Program (CUSP)/ Translating Research Into Practice (TRIP) model was used. A series of interventions were implemented: development of new blood culture procurement criteria, implementation of chlorhexidine bathing and chlorhexidine dressings, use of alcohol impregnated caps, routine performance of root-cause analysis with executive engagement, and routine central venous catheter changes. RESULTS: The use of an implementation science framework to guide multiple interventions resulted in the reduction of CLABSI rates from 15.5 per 1,000 central-line days to zero with a sustained rate of zero CLABSIs over 3 years (rate difference, 15.5; 95% confidence interval, 8.54–22.48). CONCLUSIONS: CLABSIs in high-risk units may be preventable with the a use a structured organizational and unit-level paradigm. Infect Control Hosp Epidemiol 2017;1–6

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