Primary Author:	Caitlin Hawkins, MS
Organization	University of Southern California

Abstract

Purpose

The purpose of this study is to abstract a framework to implement the best practice in reducing CLABSI through critically evaluating the literature of the central line checklist implementation from a systems perspective.

Background

Many implementation efforts have been proven successful in reducing central line associated bloodstream infection (CLABSI) rates [1], but the CDC still estimates that 200,000 CLABSI occur each year in the United States [2].

Materials & Methods

We conducted a literature review of 15 studies that tested or implemented the central line checklist. We also reviewed the literature to identify models that have been developed to address the issues of moving effective clinical evidence into practice. We completed a comparative analysis to determine how well existing models address the components identified in our framework of the checklist implementation.

Results

The critical review of the literature resulted in a four-component framework of a system to implement best practices for reducing CLABSI. The first component is tied to knowledge and accessibility of CLABSI rate data. This data triggers changes in the other three components, provider behavior, support systems, and culture. Each of these components was identified as part of the iterative change process that led to the success in reducing CLABSI. Provider behavior changed with the implementation of the checklist to follow when placing central lines followed by a change in the support system by the creation of a central line cart. The final push to complete compliance came after addressing communication issues between the nurses and physicians in the ICU. Changes are iterative with feedback driven by improvement in CLABSI rates and the checklist compliance. The comparison to existing models showed that the system view that requires all four components to be addressed in order to be successful has not been fully embraced in the literature.

Conclusion

With a critical review of the literature, a testable comprehensive system framework is proposed that can guide future implementation to achieve significant and lasting reduction in CLABSI rates.

Bibliography

Pronovost P., Vohr E. (2010). Safe Patients, Smart Hospitals. Hudson Street Press.

Maki D., Kluger, D., Crinch C. (2006). The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc, 81:1159-71.

 

© Improvement Science Research Network, 2012

The ISRN published this as received and with permission from the author(s).