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Hospitals have managed to slash CLABSI rates


As many as 200,000 central line-associated bloodstream infections have been prevented among patients in ICUs since 1990, according to a study, with progress likely stemming from prevention strategies that have become common in United States hospitals.

CLABSIs result in thousands of deaths and significant excess costs to the U.S. healthcare system. Yet research shows these infections are preventable, according to background information in the study, which is scheduled for publication in the June issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

The study, which estimated between 462,000 and 636,000 CLABSIs occurred in non-neonatal ICU patients between 1990 and 2010, found that reductions in CLABSI rates led to between 104,000 and 198,000 fewer CLABSIs than would have occurred if rates had stayed the same as they were in 1990.

“These findings suggest that technical innovations and dissemination of evidence-based CLABSI prevention practices have likely been effective on a national scale,” Matthew Wise, PhD, of the CDC’s Division of Healthcare Quality Promotion, said in a news release from the SHEA.

“These successes help bolster perceptions that healthcare-associated infections are preventable,” added Wise, the study’s lead author.

New technologies have been developed over time to prevent healthcare-associated infections in general and CLABSIs specifically, the researchers noted. CDC guidelines have promoted better central line insertion and maintenance practices. Infection control bundles, which are groups of prevention practices that are put into place at the same time and use collaborative networks of healthcare organizations to educate providers about best practices, have helped improve adherence to recommended practices.

Cultural change and the transformation in behaviors of healthcare workers significantly affect the reduction in healthcare-associated infections, as seen in the 2006 Michigan Keystone Project. The project implemented five evidence-based preventive strategies recommended by the CDC and focused on changing provider behavior through addressing safety culture, incorporating a centralized education program for team leaders at each institution and closely collaborating with infection control personnel. The intervention nearly eliminated CLABSIs in more than 100 ICUs, according to the SHEA news release.

Despite apparent success, the study researchers estimated that about 15,000 CLABSIs still occurred in ICUs during 2010, with 70% of these infections occurring in teaching hospitals with more than 200 beds. The concentration of CLABSIs among ICU patients in medium and large teaching hospitals suggests that a targeted approach may be needed to continue reducing CLABSIs among ICU patients nationally.

In a commentary published alongside the study, several limitations of this research were also noted, including the idea that every CLABSI is preventable and the possibility that zero infections may not be an achievable goal in all circumstances.

However, Eli Perencevich, MD, and colleagues called the study findings “encouraging. … Anyone who has spent the past 10 to 20 years as an infection preventionist or hospital epidemiologist can attest to how evidence-based methods and cultural change have had a real and lasting impact on infection rates.”

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