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

Published online by Cambridge University Press:  23 February 2015

Ann Scheck McAlearney*
Affiliation:
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
Affiliation:
Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio
Julie Robbins
Affiliation:
Department of Family Medicine, College of Medicine, Ohio State University, Columbus, Ohio
Michael I. Harrison
Affiliation:
Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, Maryland
Andrew Garman
Affiliation:
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 (Ann.McAlearney@osumc.edu).

Abstract

OBJECTIVE

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

DESIGN

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.

SETTING

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

PARTICIPANTS

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

RESULTS

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.

CONCLUSIONS

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

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

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