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

Published online by Cambridge University Press:  13 September 2017

Geeta Sood ,
Julie Caffrey ,
Kelly Krout ,
Zeina Khouri-Stevens ,
Kevin Gerold ,
Stefan Riedel ,
Janet McIntyre ,
Lisa L. Maragakis ,
Renee Blanding  and
Jonathan Zenilman
...Show all authors
Geeta Sood*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland
Julie Caffrey
Affiliation:
Department of Plastic Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland
Kelly Krout
Affiliation:
Johns Hopkins Bayview Medical Center, Baltimore, Maryland
Zeina Khouri-Stevens
Affiliation:
Johns Hopkins International, Johns Hopkins Aramco Hospital, Saudi Arabia
Kevin Gerold
Affiliation:
Department of Anesthesia and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Stefan Riedel
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Janet McIntyre
Affiliation:
Johns Hopkins Bayview Medical Center, Baltimore, Maryland
Lisa L. Maragakis
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland Department of Infection Prevention, Johns Hopkins Medicine, Baltimore, Maryland
Renee Blanding
Affiliation:
Department of Anesthesia and Critical Care Medicine School of Medicine, Johns Hopkins University, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
Jonathan Zenilman
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland
Richard Bennett
Affiliation:
Department of Medicine, Johns Hopkins University, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
Peter Pronovost
Affiliation:
Anesthesiology and Critical Care Medicine, Johns Hopkins University, Johns Hopkins Medicine, Baltimore, Maryland
*
Address correspondence to Geeta Sood, MD, Division of Infectious Diseases, Mason F. Lord Building, Center Tower, 3rd Floor, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Baltimore, MD, 21224 ([email protected]).
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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;38:1306–1311

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 11 , November 2017 , pp. 1306 - 1311
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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