Hostname: page-component-77c89778f8-vpsfw Total loading time: 0 Render date: 2024-07-21T00:19:30.106Z Has data issue: false hasContentIssue false

Preventing Central Line–Associated Bloodstream Infections: A Qualitative Study of Management Practices

Published online by Cambridge University Press:  23 February 2015

Ann Scheck McAlearney*
Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, Ohio
Jennifer L. Hefner
Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio
Julie Robbins
Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio
Michael I. Harrison
Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, Maryland
Andrew Garman
Department of Health Systems Management, Rush University, Chicago, Illinois National Center for Healthcare Leadership, Chicago, Illinois
Address correspondence to Ann Scheck McAlearney, ScD, MS, Department of Family Medicine, College of Medicine, Ohio State University, 2231 North High Street, 273 Northwood and High, Columbus, Ohio, 43201 (



To identify factors that may explain hospital-level differences in outcomes of programs to prevent central line–associated bloodstream infections.


Extensive qualitative case study comparing higher- and lower-performing hospitals on the basis of reduction in the rate of central line–associated bloodstream infections. In-depth interviews were transcribed verbatim and analyzed to determine whether emergent themes differentiated higher- from lower-performing hospitals.


Eight US hospitals that had participated in the federally funded On the CUSP—Stop BSI initiative.


One hundred ninety-four interviewees including administrative leaders, clinical leaders, professional staff, and frontline physicians and nurses.


A main theme that differentiated higher- from lower-performing hospitals was a distinctive framing of the goal of “getting to zero” infections. Although all sites reported this goal, at the higher-performing sites the goal was explicitly stated, widely embraced, and aggressively pursued; in contrast, at the lower-performing hospitals the goal was more of an aspiration and not embraced as part of the strategy to prevent infections. Five additional management practices were nearly exclusively present in the higher-performing hospitals: (1) top-level commitment, (2) physician-nurse alignment, (3) systematic education, (4) meaningful use of data, and (5) rewards and recognition. We present these strategies for prevention of healthcare-associated infection as a management “bundle” with corresponding suggestions for implementation.


Some of the variance associated with CLABSI prevention program outcomes may relate to specific management practices. Adding a management practice bundle may provide critical guidance to physicians, clinical managers, and hospital leaders as they work to prevent healthcare-associated infections.

Infect Control Hosp Epidemiol 2015;00(0): 1–7

Original Articles
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


1. Calfee, DP. Crisis in hospital-acquired, healthcare-associated infections. Annu Rev Med 2012;63:359371.CrossRefGoogle ScholarPubMed
2. Mermel, L.. Prevention of intravascular catheter-related infections. Ann Intern Med 2000;132:391402.Google Scholar
3. Scott, R. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. Publication no. CS200891-A. Centers for Disease Control and Prevention; 2009.Google Scholar
4. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:27252732.Google Scholar
5. Southworth, SL, Henman, LJ, Kinder, LA, Sell, JL. The journey to zero central catheter-associated bloodstream infections: culture change in an intensive care unit. Crit Care Nurse 2012;32:4954.Google Scholar
6. Lipitz-Snyderman, A, Needham, DM, Colantuoni, E, et al. The ability of intensive care units to maintain zero central line–associated bloodstream infections. Arch Intern Med 2011;171:856.Google Scholar
7. Pronovost, PJ, Goeschel, CA, Colantuoni, E, et al. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ 2010;340:c309.Google Scholar
8. Silow-Carroll, S, Edwards, JN. Eliminating central line infections and spreading success at high-performing hospitals. Synthesis Report no. 1559. The Commonwealth Fund; 2011.Google Scholar
9. Weeks, KR, Goeschel, CA, Cosgrove, SE, Romig, M, Berenholtz, SM. Prevention of central line-associated bloodstream infections: a journey toward eliminating preventable harm. Curr Infect Dis Rep 2011;13:343349.CrossRefGoogle ScholarPubMed
10. Clancy, CM. Commentary: progress on a national patient safety imperative to eliminate CLABSI. Am J Med Qual 2012;27:170171.Google Scholar
11. Manning, C, Murphy, R. Healthcare-associated infections—is targeting zero a global reality? Population Health Matters 2013;26:6.Google Scholar
12. McGoldrick, M. Preventing central line-associated bloodstream infections and the Joint Commission's home care national patient safety goals. Home Healthc Nurse 2009;27:220228.Google Scholar
13. Srinivasan, MD, Wise, M, Bell, M, et al. Vital signs: central line–associated bloodstream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011;60:243248.Google Scholar
14. AHRQ. Eliminating CLABSI, a national patient safety imperative: final report. Report no. 12-0087-EF Rockville, MD: Agency for Healthcare Research and Quality; 2013.Google Scholar
15. Dixon-Woods, M, Bosk, CL, Aveling, EL, Goeschel, CA, Pronovost, PJ. Explaining Michigan: developing an ex post theory of a quality improvement program. Milbank Q 2011;89:167205.Google Scholar
16. Glaser, B, Strauss, A. The constant comparative method of qualitative analysis. In: The Discovery of Grounded Theory: Strategies for Qualitative Research. New York: Aldine de Gruyter; 1967:101115.Google Scholar
17. Constas, MA. Qualitative analysis as a public event: the documentation of category development procedures. Am Educ Res J 1992;29:253266.Google Scholar
18. Scientific Software Development. Atlas.ti. 2008.Google Scholar
19. Kaplan, HC, Brady, PW, Dritz, MC, et al. The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q 2010;88:500559.Google Scholar
20. Leonard, M, Graham, S, Bonacum, D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004;13:i85i90.Google Scholar
21. Poon, EG, Blumenthal, D, Jaggi, T, Honour, MM, Bates, DW, Kaushal, R. Overcoming barriers to adopting and implementing computerized physician order entry systems in US hospitals. Health Aff 2004;23:184190.Google Scholar
22. Taylor, SL, Dy, S, Foy, R, et al. What context features might be important determinants of the effectiveness of patient safety practice interventions? BMJ Qual Saf 2011;20:611617.Google Scholar
24. Kuehn, BM. Hospitals slash central line infections with program that empowers nurses. JAMA 2012;308:16171618.Google Scholar