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December 2012, Volume 42 Number 12 , p 19 - 21



Studies have shown that most central line-associated bloodstream infections (CLABSIs) are preventable, especially when clinicians consistently apply a "bundle" of proven interventions. To establish a causal relationship between multifaceted interventions and reduced CLABSI rates in the ICU, researchers conducted a multicenter trial involving 35 hospitals and 45 ICUs. The hospitals were randomly selected for either an intervention group or a control group. The multifaceted intervention involved five evidence-based practices to prevent CLABSI combined with the Comprehensive Unit-Based Safety Program (CUSP), which is designed to improve patient safety, communication, and teamwork. The six-step CUSP intervention included these components: * evaluation of the facility's culture of safety * science of safety training to educate clinicians about systems and safe design * identification of how patients are or could be harmed and suggested solutions * partnering with a facility executive to support safety initiatives * regular examination of identified system defects and implementation of tools to improve teamwork and communication * reevaluation of culture.The study measured CLABSI per 1,000 central line days, reported quarterly during the study period. The baseline averages were 4.48 for the intervention group and 2.71 for the control group.Within a few months, the infection rate in the intervention group dropped to 1.33 compared with 2.16 in the control group. At 19 months, the intervention group sustained CLABSI rates of less than 1/1,000 central line days (an 81% reduction). At 12 months, the control group reduced CLABSI to less than 1/1,000 (a 69% reduction)."Infection rates were dramatically reduced and sustained in the intervention group and replicated in the control group," the researchers report. "Furthermore, structuring this collaborative as a nurse-led intervention was successful and confirms the logical role for nurses in quality improvement interventions."Source:

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