• Marta L Render, Rachael Hasselbeck, Ron W Freyberg, Timothy P Hofer, Anne E Sales, Peter L Almenoff, and VA ICU Clinical Advisory Group.
• VA Inpatient Evaluation Center, Cincinnati VAMC, Cincinnati, Ohio 45220, USA. marta.render@va.gov
• BMJ Qual Saf. 2011 Aug 1;20(8):725-32.

BackgroundElimination of hospital-acquired infections is an important patient safety goal.SettingAll 174 medical, cardiac, surgical and mixed Veterans Administration (VA) intensive care units (ICUs).InterventionA centralised infrastructure (Inpatient Evaluation Center (IPEC)) supported the practice bundle implementation (handwashing, maximal barriers, chlorhexidinegluconate site disinfection, avoidance of femoral catheterisation and timely removal) to reduce central line-associated bloodstream infections (CLABSI). Support included recruiting leadership, benchmarked feedback, learning tools and selective mentoring.Data CollectionSites recorded the number of CLABSI, line days and audit results of bundle compliance on a secure website.AnalysisCLABSI rates between years were compared with incidence rate ratios (IRRs) from a Poisson regression and with National Healthcare Safety Network referent rates (standardised infection ratio (SIR)). Pearson's correlation coefficient compared bundle adherence with CLABSI rates. Semi-structured interviews with teams struggling to reduce CLABSI identified common themes.ResultsFrom 2006 to 2009, CLABSI rates fell (3.8-1.8/1000 line days; p<0.01); as did IRR (2007; 0.83 (95% CI 0.73 to 0.94), 2008; 0.65 (95% CI 0.56 to 0.76), 2009; 0.47 (95% CI 0.40 to 0.55)). Bundle adherence and CLABSI rates showed strong correlation (r = 0.81). VA CLABSI SIR, January to June 2009, was 0.76 (95% CI 0.69 to 0.90), and for all FY2009 0.88 (95% CI 0.80 to 0.97). Struggling sites lacked a functional team, forcing functions and feedback systems.ConclusionCapitalising on a large healthcare system, VA IPEC used strategies applicable to non-federal healthcare systems and communities. Such tactics included measurement through information technology, leadership, learning tools and mentoring.

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