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Center for Health Services and Outcomes Research

Patient Safety

Linking Blood Stream Infections to Intensive Care Nursing Context of Care and Process

A collaborative effort to reduce central line-associated bloodstream infections (CLABSI) was implemented and evaluated in intensive care units in two large faith-based systems. The intervention group sustained rates <1 infection per 1,000 central line days at 19 months (an 81% reduction). The control group became a second intervention group and reduced infection rates to <1/1,000 central line days (a 69% reduction) at 12 months. This study demonstrated a causal relationship between the multifaceted intervention and the reduced central line-associated bloodstream infections. Both groups decreased infection rates after implementation and sustained these results over time, replicating the results found in previous pre-post studies of this intervention and providing further evidence that most central line-associated bloodstream infections are preventable.

The project also showed that nursing care hours per patient day greater than 20 hours were associated with lower CLABSI rates. Increasing nursing hours per patient day was also associated with shorter LOS, with the strongest relationship where nursing hours per patient day were lower (< 20 hours compared to ≥ 20 hours). A higher skill mix was associated with shorter LOS but higher CLABSI rates. We found no significant relationships of nursing turnover with any outcome, or between any nursing variables and patient mortality. Our findings suggest that nursing care hours per patient day and nursing skill mix significantly contribute to CLABSI prevention and LOS in the ICU setting.

Publications:

Marsteller JA, Sexton JB, Hsu YJ, Hsaio CJ, Pronovost PJ, Thompson, D. (2012). A Multicenter Phased Cluster-Randomized Controlled Trial to Reduce Central Line Associated Blood Stream Infections.” Critical Care Medicine, 2012 Aug 10. [Epub ahead of print].

Thompson DA, Hsu YJ, Chang BH,  Marsteller JA (2013). Impact of nursing staffing on patient outcomes in intensive care units.  Journal of Nursing Care 2: 128.