Evidence-based practice to reduce central line infections

Jt Comm J Qual Patient Saf. 2006 May;32(5):253-60. doi: 10.1016/s1553-7250(06)32033-8.


Background: In 2003, through the Greater Cincinnati Health Council nine health care systems agreed to participate and fund 50% of a two-year project to reduce hospital-acquired infections among patients in intensive care units (ICU) and following surgery (SIP).

Methods: Hospitals were randomized to either the CR-BSI or SIP project in the first year, adding the alternative project in year 2. Project leaders, often the infection control professionals, implemented evidence-based practices to reduce catheter-related blood stream infections (CR-BSIs; maximal sterile barriers, chlorhexidine) at their hospitals using a collaborative approach. Team leaders entered process information in a secure deidentifled Web-based database.

Results: Of the four initial sites randomized to CR-BSI reduction, all reduced central line infections by 50% (CR-BSI, 1.7 to 0.4/1000 line days, p < .05). At the project midpoint (3 quarters of 2004), adherence to evidence-based practices increased from 30% to nearly 95%.

Discussion: The direct role of hospital leadership and development of a local community of practice, facilitated cooperation of physicians, problem solving, and success. Use of forcing functions (removal of betadine in kits, creation of an accessory pack and a checklist for line insertion) improved reliability. The appropriate floor for central line infections in ICUs is < 1 infection /1,000 line days.

MeSH terms

  • Awards and Prizes
  • Catheterization, Central Venous / adverse effects*
  • Cross Infection / prevention & control*
  • Evidence-Based Medicine*
  • Humans
  • Intensive Care Units / organization & administration
  • Multi-Institutional Systems
  • Ohio
  • Quality Assurance, Health Care