Payal K. Patel, MD, MPH; Russell N. Olmsted, MPH, CIC; Louella Hung, MPH; Kyle J. Popovich, MD, MS; Jennifer Meddings, MD, MSc; Karen Jones, RN, MPH, CIC; David P. Calfee, MD, MS; Karen E. Fowler, MPH; Sanjay Saint, MD, MPH; Vineet Chopra, MD, MSc
Disclaimer: The findings and conclusions in this report are those of the authors and do not represent the official position of the CDC, the American Hospital Association, or the Department of Veterans Affairs.
Acknowledgment: The authors thank the Health Research & Educational Trust (HRET) Health Care–Associated Infection team, as well as the National Program Team and all members of the CDC STRIVE collaborative.
Financial Support: Dr. Meddings' work was partially funded by concurrent support from the Agency for Healthcare Research and Quality (AHRQ) (K08 HS19767).
Disclosures: Dr. Patel, Dr. Meddings, Ms. Fowler, Dr. Saint, and Dr. Chopra report a CDC contract with HRET, which subcontracted with the University of Michigan to support faculty/staff effort for this contract, during the conduct of the study. Mr. Olmsted reports personal fees from a the HRET during the conduct of the study and personal fees from Ethicon outside the submitted work. Ms. Hung reports a CDC contract with HRET during the conduct of the study. Dr. Popovich reports personal fees from a CDC contract with HRET during the conduct of the study. Dr. Meddings also reports an AHRQ K08 grant during the conduct of the study; employment by the University of Michigan Medical School (Michigan Medicine), VA Ann Arbor Healthcare System, and the Center for Clinical Management Research; being an investigator on an AHRQ contract with HRET; and receipt of honoraria for presentations from various professional and nonprofit organizations and QuantiaMD outside the submitted work. In addition, Dr. Meddings' research involves development of products to improve patient safety by reducing hospital-acquired complications, and her team has a provisional patent involving one of these products (US20180339133A1). She has no associations with any companies or manufacturers, has no ownership in a commercial entity, and receives no royalties. Ms. Jones reports a CDC contract with an HRET subcontract during the conduct of the study. Dr. Calfee reports a CDC contract with the HRET, which subcontracted with Weill Cornell Medical College, during the conduct of the study. Dr. Saint also reports personal fees from Doximity and Jvion outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3469.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Corresponding Author: Payal K. Patel, MD, MPH, VA Ann Arbor Healthcare System, 111-I, 2215 Fuller Road, Ann Arbor, MI 48105; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Patel: Veterans Affairs Ann Arbor Healthcare System, 111-I, 2215 Fuller Road, Ann Arbor, MI 48105.
Mr. Olmsted: Integrated Clinical Services, Trinity Health, 20555 Victor Parkway, Livonia, MI 48152.
Ms. Hung: Health Research & Educational Trust, 155 North Upper Wacker Drive, #400, Chicago, IL 60606.
Dr. Popovich: Rush University Medical Center, 600 South Paulina, Suite 143, Chicago, IL 60612.
Dr. Meddings, Saint, and Chopra: University of Michigan Department of Internal Medicine, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI 48109-2800.
Ms. Jones: University of Michigan Geriatrics, 300 North Ingalls Building, Room 914, Ann Arbor, MI 48109-2007.
Dr. Calfee: Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065.
Ms. Fowler: Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI 48113-0170.
Author Contributions: Conception and design: P.K Patel, R.N. Olmsted, L. Hung, J. Meddings, D.P. Calfee, K.E. Fowler, S. Saint, V. Chopra.
Analysis and interpretation of the data: P.K Patel, R.N. Olmsted, L. Hung, D.P. Calfee, V. Chopra.
Drafting of the article: P.K Patel, K. Jones, V. Chopra.
Critical revision of the article for important intellectual content: P.K Patel, R.N. Olmsted, L. Hung, K.J. Popovich, J. Meddings, K. Jones, D.P. Calfee, K.E. Fowler, S. Saint, V. Chopra.
Final approval of the article: P.K Patel, R.N. Olmsted, L. Hung, K.J. Popovich, J. Meddings, D.P. Calfee, K.E. Fowler, S. Saint, V. Chopra.
Obtaining of funding: S. Saint, V. Chopra.
Administrative, technical, or logistic support: L. Hung, J. Meddings, K. Jones, K.E. Fowler.
Tiers of interventions to prevent CLABSI.
This material was expanded, enhanced, and adapted from materials developed for catheter-associated urinary tract infection prevention by faculty and staff at the Department of Veterans Affairs and the University of Michigan, with funding support from the Agency for Healthcare Research and Quality. Further adaptation was done with funding support from the Centers for Disease Control and Prevention. For detailed information on tier 1 and tier 2 interventions, resources, and references, see the Supplement. CLABSI = central line–associated bloodstream infection; CVC = central venous catheter; GPS = guide to patient safety; TAP = Targeted Assessment for Prevention.
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Patel PK, Olmsted RN, Hung L, et al. A Tiered Approach for Preventing Central Line–Associated Bloodstream Infection. Ann Intern Med. 2019;171:S16–S22. doi: https://doi.org/10.7326/M18-3469
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Published: Ann Intern Med. 2019;171(7_Supplement):S16-S22.
Hospital-Acquired Infections, Infectious Disease, Multi-Organ Failure and Sepsis, Pulmonary/Critical Care.
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