The challenge
Catheter-related bloodstream infections in intensive care units were common, costly and potentially lethal.
The case
In the Keystone ICU project, funded by the federal Agency for Healthcare Research and Quality, the Michigan Hospital Association and Johns Hopkins researchers led by Peter Pronovost worked with intensive care units across Michigan; 103 of them reported data. Teams used an evidence-based intervention to reduce catheter-related bloodstream infections, alongside work on safety culture. The median infection rate fell from 2.7 per 1,000 catheter-days to 0 within three months, and the mean from 7.7 to 1.4 after 16–18 months, a reduction of up to 66%. Hospital deaths among patients 65 and over then fell significantly more in Michigan than elsewhere in the Midwest.
Why it worked
A later randomised trial of the same approach in other hospitals confirmed that it caused the fall, and concluded that most of these infections are preventable.
Sources
- Pronovost, P., Needham, D., Berenholtz, S., et al. (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine, 355(26), 2725–2732.
- AHRQ Patient Safety Network. Improving patient safety in intensive care units in Michigan.
- Lipitz-Snyderman, A., Steinwachs, D., Needham, D. M., et al. (2011). Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis. BMJ, 342, d219.
- Marsteller, J. A., Sexton, J. B., Hsu, Y.-J., et al. (2012). A multicenter, phased, cluster-randomized controlled trial to reduce central line-associated bloodstream infections in intensive care units. Critical Care Medicine, 40(11), 2933–2939.
Spot an error or know a better source? Tell us