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April 2010, Volume 40 Number 4 , p 21 - 23



Partnering with researchers at The Johns Hopkins University School of Medicine in Baltimore, Michigan adopted a statewide standardized catheter-related bloodstream infection (CBSI) prevention program designed to eliminate CBSI. After 18 months, the number of CBSI in most Michigan ICUs was zero. Three years later, CBSI rates in participating ICUs remains near zero—a "breath- taking" achievement, says lead researcher Peter J. Pronovost, MD, PhD. Before implementing the safety plan, the median rate of CBSI in Michigan ICUs was about 3 per 1,000 catheter-hours, higher than the national average.The 3-year follow-up study is one of the first to show that quality-improvement results can be sustained over time.The heart of the program is a 5-point checklist summarizing evidence-based recommendations for clinicians to follow when placing a central venous catheter: * wash hands * clean patient's skin with chlorhexidine * use full barrier precautions * avoid using femoral site whenever possible * remove unnecessary catheters.The program also includes education about infection control for clinicians and use of standardized supply carts controlled for one-time use. In addition, the program requires any member of the healthcare team to issue a "stop now" order if any checklist item hasn't been followed meticulously. Clinicians receive regular feedback about the number and rates of CBSI at weekly and quarterly meetings.Pronovost says the program's success reflects a fundamental change in the way nurses and healthcare providers think about these infections. Although a few CBSI were once regarded as inevitable in ICUs, this study proves that, in fact, they're "universally preventable."It also represents a cultural shift to an ICU environment in which "nurses question doctors who don't wash their hands or use the checklist diligently," Pronovost says.Sources: Pronovost PJ, Goeschel CA, Colantuoni E, et al. Sustaining reductions in catheter related bloodstream

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