Implementing a management practice bundle that provides critical guidance to physicians, clinical managers, and hospital leaders may improve efforts to prevent central-line-associated bloodstream infections (CLABSIs), concludes a study published online Feb 23, 2015, Infection Control & Hospital Epidemiology. The researchers interviewed leaders, clinical leaders, professional staff, and frontline physicians and nurses at eight U.S. hospitals that participated in the federally funded On the CUSP: Stop BSI initiative to determine whether themes emerged differentiating hospitals with higher performance in CLABSI reduction from those with lower performance. They found that the main theme that differentiated higher- from lower-performing hospitals was a distinctive framing of the goal of "getting to zero" infections. At the higher-performing sites, this goal was explicitly stated, widely embraced, and aggressively pursued as achievable; however, at the lower-performing hospitals, the goal was more of an aspiration, and many interviewees suggested they did not actually believe it was "realistic" to completely eliminate CLABSIs. Other management practices identified in the study that were nearly exclusively present in the higher-performing hospitals included (1) the commitment of top-level leadership; (2) a strong alignment and collaboration between physician and nurse leaders at all organizational levels; (3) a systematic, comprehensive, and repetitive approach to education; (4) the meaningful use of data to inform all staff of rates and trends; and (5) the provision of recognition and rewards when goals and milestones were met. The researchers present these practices as a bundle with recommendations for implementation but mention that they do not suggest broadly implementing it in its current form. They emphasize that additional research is needed to evaluate their findings and weigh the value of each strategy identified.

HRC Recommends: Healthcare-acquired infections such as CLABSI have the attention of regulators and the public. Studies such as this one can be used by organizations' leadership to emphasize that elimination of these infections is achievable. In addition to the bundle of strategies listed here, risk managers can emphasize a group of interventions known as the Central Line Bundle, which consists of the following five components: hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, appropriate catheter site selection and postplacement care, and daily review of line necessity with prompt removal of unnecessary lines. In combination with a culture of safety and emphasis on teamwork, the Central Line Bundle can help organizations reduce their rates of central-line infections significantly.