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One of the Joint Commission’s 2013 patient safety goals calls for hospitals to implement “evidence-based practices to prevent central line–associated bloodstream infections. This requirement covers short- and long-term central venous catheters and peripherally inserted central catheter (PICC) lines.”
A good source of such practices was recently published in the accreditation agency’s peer-reviewed publication, The Joint Commission Journal on Quality and Patient Safety . The authors described a collaborative statewide program in Hawaii that reduced CLABSIs by 82% in ICUs and non-ICUs over 36-month between 2009 and 2012. (1)
The reductions were attributed to infection prevention interventions during the insertion of catheters and efforts to improve the maintenance of existing lines. A series of strategies and tools were implemented to aggregate statewide CLABSI information, learn from patterns and clusters of infections, understand cultural barriers, create new avenues for discussion with leadership, and ensure ownership with new team members.
Hawaii joined the On the CUSP: Stop BSI national effort in the United States in 2009 (CUSP stands for Comprehensive Unit-based Safety Program). In the initial 18-month study evaluation, adult ICUs decreased central line-associated bloodstream infection (CLABSI) rates by 61%. The impact of a series of novel strategies/tools in reducing infections and sustaining the collaborative in ICUs and non–ICUs in Hawaii was assessed. The tools included a “The Dirty Dozen” Maintenance video, ( http://www.youtube.com/watch?v=v5AOjnx077k ) which was produced and offered to participating hospitals starting in January 2011 to increase nurse competency regarding the latest evidence-based practices for central line maintenance. The video was developed after Hawaii’s teams “walked the process” to understand barriers to practicing evidence-based care.
For more on this story see the July issue of Hospital Infection Control & Prevention.
Lin, DM, Weeks K, Holzmueller CG, et al. Maintaining and Sustaining the On the CUSP: Stop BSI Model in Hawaii. Joint Comm Jrl Qual Pt Safe 2013; 39;51-60