Kathleen McMullen MPH CIC, FAPIC, FSHEA (is Executive Director, Infection Prevention and Sterilization, Mercy Center for Quality and Safety, Chesterfield, Missouri.), Fran Hixson RN, BSN, CIC (is Manager, Clinical Quality, and Clinical Quality Lead, Mercy Center for Quality and Safety.), Megan Peters RN, CIC (is Manager, Infection Prevention, Mercy Center for Quality and Safety.), Kathryn Nelson MHA (is Chief Quality Officer, Mercy Center for Quality and Safety.), William Sistrunk MD, FACP (is Infectious Diseases Physician, Mercy Center for Quality and Safety.), Jeff Reames MD, MBA, FACEP (formerly Regional Director of Emergency Medicine, Mercy Health System of Oklahoma, is Emergency Medicine Consultant, Mercy Center for Quality and Safety.), Cynthia Standlee RN (is Chief Nursing Officer, Mercy Hospital, Ada, Oklahoma.), David Tannehill DO, FACOI, FACP (is Chief Medical Officer, Mercy Hospital, Washington, Missouri.), Keith Starke MD, FACP (is Senior Advisor, Office of Clinical Excellence, Mercy Center for Quality and Safety. Please address correspondence to Kathleen McMullen)
{"title":"Prevention of Central Line–Associated Bloodstream Infections by Leadership Focus on Process Measures","authors":"Kathleen McMullen MPH CIC, FAPIC, FSHEA (is Executive Director, Infection Prevention and Sterilization, Mercy Center for Quality and Safety, Chesterfield, Missouri.), Fran Hixson RN, BSN, CIC (is Manager, Clinical Quality, and Clinical Quality Lead, Mercy Center for Quality and Safety.), Megan Peters RN, CIC (is Manager, Infection Prevention, Mercy Center for Quality and Safety.), Kathryn Nelson MHA (is Chief Quality Officer, Mercy Center for Quality and Safety.), William Sistrunk MD, FACP (is Infectious Diseases Physician, Mercy Center for Quality and Safety.), Jeff Reames MD, MBA, FACEP (formerly Regional Director of Emergency Medicine, Mercy Health System of Oklahoma, is Emergency Medicine Consultant, Mercy Center for Quality and Safety.), Cynthia Standlee RN (is Chief Nursing Officer, Mercy Hospital, Ada, Oklahoma.), David Tannehill DO, FACOI, FACP (is Chief Medical Officer, Mercy Hospital, Washington, Missouri.), Keith Starke MD, FACP (is Senior Advisor, Office of Clinical Excellence, Mercy Center for Quality and Safety. Please address correspondence to Kathleen McMullen)","doi":"10.1016/j.jcjq.2024.10.012","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The coronavirus disease 2019 (COVID-19) pandemic affected quality improvement work that was key to hospital-acquired infection (HAI) prevention efforts for many hospitals. Central line–associated bloodstream infection (CLABSI) standardized infection ratios (SIRs) were highly affected by the pandemic.</div></div><div><h3>Methods</h3><div>After seeing an increase in CLABSI SIRs through early 2021, a health care system including 12 acute care hospitals in the midwestern United States focused on processes and process measures for CLABSI prevention. Each hospital was asked to identify a medical provider, nursing, and infection prevention lead to champion the work (identified as a CLABSI triad). CLABSI triads emphasized best practice expectations, standardized technology and products, and implemented reporting and trending of compliance. Work started in July 2021, with multiple initiatives rolled out through the end of 2022. CLABSI SIRs and standardized utilization ratios (SURs) were analyzed with interrupted time series analysis; changes in several process measures were analyzed using Wilcoxon rank sum exact testing.</div></div><div><h3>Results</h3><div>A 47.5% decrease was seen in CLABSI SIR through the study period, with SIR = 0.61 from 2023 to April 2024. The slope of the trend line for CLABSI SIR and central line utilization had a significant downward trend in the intervention time frame (<em>p</em> = 0.04 and <em>p</em> < 0.01, respectively). CLABSI prevention best practices improved statistically during the study period.</div></div><div><h3>Conclusion</h3><div>Intense focus by leadership on key CLABSI prevention process measures was associated with lower CLABSI SIRs.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 2","pages":"Pages 126-134"},"PeriodicalIF":2.3000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725024003301","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
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Abstract
Background
The coronavirus disease 2019 (COVID-19) pandemic affected quality improvement work that was key to hospital-acquired infection (HAI) prevention efforts for many hospitals. Central line–associated bloodstream infection (CLABSI) standardized infection ratios (SIRs) were highly affected by the pandemic.
Methods
After seeing an increase in CLABSI SIRs through early 2021, a health care system including 12 acute care hospitals in the midwestern United States focused on processes and process measures for CLABSI prevention. Each hospital was asked to identify a medical provider, nursing, and infection prevention lead to champion the work (identified as a CLABSI triad). CLABSI triads emphasized best practice expectations, standardized technology and products, and implemented reporting and trending of compliance. Work started in July 2021, with multiple initiatives rolled out through the end of 2022. CLABSI SIRs and standardized utilization ratios (SURs) were analyzed with interrupted time series analysis; changes in several process measures were analyzed using Wilcoxon rank sum exact testing.
Results
A 47.5% decrease was seen in CLABSI SIR through the study period, with SIR = 0.61 from 2023 to April 2024. The slope of the trend line for CLABSI SIR and central line utilization had a significant downward trend in the intervention time frame (p = 0.04 and p < 0.01, respectively). CLABSI prevention best practices improved statistically during the study period.
Conclusion
Intense focus by leadership on key CLABSI prevention process measures was associated with lower CLABSI SIRs.
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