A Multicenter, Phased, Cluster-Randomized Controlled Trial to Reduce Central Line-associated Bloodstream Infections in Intensive Care Units
There is a causal relationship between the implementation of a previously developed intervention and a “dramatic” reduction of central line-associated bloodstream infections in Intensive Care Units (ICUs). The success of this nurse-led collaborative underscores the role of nurses in quality improvement.
Nearly 250,000 central line-associated bloodstream infections (CLABSIs) occur each year, resulting in 31,000 deaths and costing $9 billion. Previous research demonstrated that when a particular bundle of evidence-based practices to reduce bloodstream infections was implemented with a program to improve patient safety, communication and teamwork, CLABSIs were reduced by 61 percent. But this research did not establish a causal link. In this new study, 45 intensive care units located in 12 states and associated with two different health care systems, participated in a randomized, controlled trial to demonstrate the causal link between the intervention and a CLABSI decline. The intervention was later implemented in the control group as well. The study took place March 2007-September 2008.
- Nine months after implementation in the intervention group, CLABSIs were reduced by 70 percent, from 4.5 infections/1,000 line days at baseline to 1.3 infections; infections in the control group naturally fell by 21 percent during the same period.
- Nineteen months after implementation, CLABSIs in the intervention group were reduced by 81 percent.
- One-year after the intervention was introduced into the control group, infections had already fallen by an accelerated 69 percent.
- By the study’s end, CLABSIs in both groups had been reduced to 0.8/1,000 line days.
The study proved a causal link between the intervention and a substantial, sustained reduction in infection. It also demonstrated that the reduction could be replicated when the intervention was introduced later to the control. Moreover, CLABSIs could be reduced to nearly zero and thus, are largely preventable. This nurse-led collaboration also demonstrated the role of nurses in driving quality improvement.