Payal K. Patel, MD, MPH; M. Todd Greene, PhD, MPH; Karen Jones, RN, MPH; Andrew J. Rolle, MPH; David Ratz, MS; Ashley Snyder, 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) Healthcare-Acquired Infection team, the National Program Team and all members of the CDC STRIVE collaborative. The authors also thank Jessica Ameling, MPH; Rachel Ehrlinger, BA; Jason Engle, BS; Karen E. Fowler, MPH; and Jason Mann, MSA, for assistance with manuscript preparation.
Disclosures: Dr. Patel, Dr. Greene, Mr. Ratz, Ms. Snyder, 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. Ms. Jones reports a CDC contract with an HRET subcontract during the conduct of the study. Mr. Rolle reports a CDC contract to the HRET during the conduct of the study. Dr. Saint also reports personal fees from Doximity and Jvion during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3533.
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.
Reproducible Research Statement: Study protocol: Not applicable. Statistical code: Available from David Ratz (e-mail, email@example.com). Data set: Not available.
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.
Drs. Greene, Saint, and Chopra, and Ms. Snyder: University of Michigan Department of Internal Medicine, 2800 Plymouth Road, NCRC Building 16, Room 430W Ann Arbor, MI 48109-2800.
Mr. Rolle: Health Research & Educational Trust, American Hospital Association, 155 North Wacker Drive, Suite 400, Chicago, IL 60606.
Mr. Ratz: VA Ann Arbor Healthcare System Center for Clinical Management Research, PO Box 130170, Ann Arbor, MI 48113-0170.
Ms. Jones: University of Michigan Geriatrics, 300 North Ingalls Building, Room 914, Ann Arbor, MI 48109-2007.
Author Contributions: Conception and design: P.K. Patel, M.T. Greene, A.J. Rolle, S. Saint, V. Chopra.
Analysis and interpretation of the data: P.K. Patel, M.T. Greene, D. Ratz, A. Snyder, S. Saint, V. Chopra.
Drafting of the article: P.K. Patel, M.T. Greene, K. Jones, V. Chopra.
Critical revision of the article for important intellectual content: P.K. Patel, M.T. Greene, K. Jones, A.J. Rolle, D. Ratz, S. Saint, V. Chopra.
Final approval of the article: P.K. Patel, M.T. Greene, K. Jones, A.J. Rolle, D. Ratz, A. Snyder, S. Saint, V. Chopra.
Provision of study materials or patients: A.J. Rolle.
Statistical expertise: M.T. Greene, D. Ratz, A. Snyder, V. Chopra.
Obtaining of funding: S. Saint.
Administrative, technical, or logistic support: K. Jones.
Collection and assembly of data: A.J. Rolle.
Central line–associated bloodstream infection (CLABSI) remains prevalent in hospitals in the United States.
To evaluate the impact of a multimodal intervention in hospitals with elevated rates of health care–associated infection.
Pre–post observational evaluation of a prospective, national, clustered, nonrandomized initiative of 3 cohorts of hospitals.
Acute care, long-term acute care, and critical access hospitals, including intensive care units and medical/surgical wards.
Target hospitals had a cumulative attributable difference above the first tertile of performance for Clostridioides difficile infection and another health care–associated infection (such as CLABSI). Some hospitals that did not meet these criteria also participated.
A multimodal intervention consisting of recommendations and tools for prioritizing and implementing evidence-based infection prevention strategies, on-demand educational videos, webinars led by content experts, and access to content experts.
Rates of CLABSI and device utilization ratio pre- and postintervention.
Between November 2016 and May 2018, 387 hospitals in 23 states and the District of Columbia participated. Monthly preimplementation CLABSI rates ranged from 0 to 71.4 CLABSIs per 1000 catheter-days. Over the study period, the unadjusted CLABSI rate was low and decreased from 0.88 to 0.80 CLABSI per 1000 catheter-days. Between the pre- and postintervention periods, device utilization decreased from 24.05 to 22.07 central line–days per 100 patient-days. However, a decreasing trend in device utilization was also observed during the preintervention period.
The intervention period was brief. Participation in and adherence to recommended interventions were not fully assessed. Rates of CLABSI were low. Patient characteristics could not be assessed.
In hospitals with a disproportionate burden of health care–associated infection, a multimodal intervention did not reduce rates of CLABSI.
Centers for Disease Control and Prevention.
STRIVE project timeline.
Outcome data were central line–associated bloodstream infections as reported by participating hospitals to the CDC National Healthcare Safety Network. CDC = Centers for Disease Control and Prevention; ICAR = Infection Control Assessment and Response; PCA = Practice Change Assessment; SHA = state hospital association; STRIVE = States Targeting Reduction in Infections via Engagement; TAP = Targeted Assessment for Prevention.
Study flow diagram.
CAD = cumulative attributable difference; CDC = Centers for Disease Control and Prevention; CLABSI = central line–associated bloodstream infection; HAI = health care–associated infection; NHSN = National Healthcare Safety Network.
* “States” includes the District of Columbia.
† “Withdrew” defined as hospital and state jointly decided the hospital would stop participating in the program.
‡ 213 hospitals self-reported that they focused on CLABSI prevention during the program.
Table 1. Characteristics of the 337 Participating Hospitals That Submitted CLABSI Data*
CLABSI per 1000 central line–days and central line utilization per 100 patient-days for the 337 hospitals that provided CLABSI data.
Rates are shown by month for the 12-month preintervention (baseline) and 12-month postintervention periods. The solid line represents the monthly rates; dashed lines represent the 95% CIs. B = baseline month; CLABSI = central line–associated bloodstream infection; M = intervention month.
Appendix Table 1. Aggregated Monthly CLABSI and Central Line Utilization Data From the 337 Participating Hospitals That Submitted CLABSI Data
Table 2. Pre- and Postintervention CLABSI Data, by Hospital Type
Hospital-level CLABSI rates during the pre- and postintervention periods (n = 332).
In this Sankey bar chart, the connecting segments show how hospitals changed from the pre- to the postintervention periods. The slopes of the connecting segments should be interpreted cautiously because some segments connecting to the same rate category are increasing or decreasing visually but indicate no change in rates in these hospitals. Only segments that connect to a different category indicate changes in rates from the pre- to the postintervention period. CLABSI = central line–associated bloodstream infection.
Appendix Table 2. Comparison of CLABSI Rates Between the Pre- and Postintervention Periods
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Patel PK, Greene MT, Jones K, et al. Quantitative Results of a National Intervention to Prevent Central Line–Associated Bloodstream Infection: A Pre–Post Observational Study. Ann Intern Med. 2019;171:S23–S29. doi: https://doi.org/10.7326/M18-3533
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Published: Ann Intern Med. 2019;171(7_Supplement):S23-S29.
Hospital Medicine, Hospital-Acquired Infections, Infectious Disease, Multi-Organ Failure and Sepsis, Pulmonary/Critical Care.
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