Preventing central line-associated bloodstream infections: a qualitative study of management practices.

Scheck McAlearney A1, Hefner JL1, Robbins J1, Harrison MI2, Garman A3.

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Abstract

OBJECTIVE:

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

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 preventinfections. 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.