Research Shows “Best Achievable” Time Periods for Sustainability of Zero CLABSIs

June 4, 2011

Sustainability of Zero Central Line-Associated Bloodstream Infections (CLABSI) Over Time

Recent research presented in the May 9, ed 2011 issue of the Archives of Internal Medicine, pharmacy quantified “the ability of intensive care units (ICUs) to sustain zero central line-associated bloodstream infections (CLABSIs) over time.”

The authors, led by Dr. Allison Lipitz-Snyderman of the Quality & Safety Research Group at Johns Hopkins University, expressed the importance of knowing this performance information of duration of time without infection:

Despite evidence demonstrating reduced infection rates from evidence-based interventions for CLABSIs, the field has not yet defined the attainable duration of time hospitals can go without a CLABSI. Without understanding “best achievable” time without any infection, hospitals may anchor themselves, and public expectations, to suboptimal performance. Such data are required to establish performance benchmarks that represent best practices, create realistic public expectations, motivate internal improvement efforts, and design fair pay-for-performance policies.

ICUs Formerly Participating in the Michigan Keystone ICU Project

The researchers examined data from ICUs that previously participated in the Michigan Keystone ICU Project. Data were obtained from 80 ICUs located within 57 hospitals. The time period reviewed covered up to 4 years of CLABSI data (March 2004 to February 2008).

The primary outcome the researchers were searching for “was the greatest number of consecutive months with zero CLABSIs reported during the study period for each ICU.” Secondary outcomes studied were ICUs sustaining zero CLABSIs for 12 and 24 consecutive months.

Results: Best Achievable Time Period of Zero CLABSIs

The study results showed the mean (SD) and median (IQR) consecutive number of months with zero CLABSIs in all 80 ICUs studied was 16.5 (10.8) and 15 (6.0-25.5) respectively. Sixty percent of the 80 ICUs were able to sustain zero CLABSIs for 12 months or longer and 26% achieved 24 months or more.

The researches also considered teaching status and bed size factors. For both teaching and non-teaching hospital categories, the above outcome measures decreased as the bed size of the hospital increased. Generally, as compared to teaching hospitals, nonteaching hospitals experienced higher numbers of consecutive months with zero CLABSIs and a greater proportion of ICUs with zero CLABSI sustainability for 12 and 24 months.

[box style=”rounded”]”Overall, the majority of ICUs achieved 12 months or more without a reported CLABSI, and more than quarter achieved 24 months or more.”[/box]

Importance of the Findings

The authors note the importance of these findings: “in the setting of a comprehensive initiative focused on reducing CLABSIs, extended periods without infections are possible ….” “As such, incentives for hospitals to implement and sustain evidence-based infection prevention initiatives appear warranted.”

Reference: Lipitz-Snyderman, A, Needham, DM, Colantuoni, E, et al. (2011). The Ability of Intensive Care Units to Maintain Zero Central Line-Associated Bloodstream Infections. Archives of Internal Medicine, 171(9):856-858.

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