Sustaining reductions in central line–associated bloodstream infections in Michigan intensive care units: a 10-year analysis.
Approach to Improving Safety
Setting of Care
A major challenge in improving patient safety is sustaining gains from new interventions over time. The landmark Michigan Keystone ICU project was a large-scale quality improvement effort that led to near elimination of central line–associated bloodstream infections (CLABSIs). This study examined practices to prevent CLABSIs in Michigan over the 10 years following that study. Investigators found a continued decline in CLABSIs from 2005 through 2013, with many participating hospitals reaching the benchmark rate of less than 1 CLABSI per 1000 hospital days after the initial project period ended. The authors credit robust training in change management principles and ongoing support for maintaining CLABSI prevention work. They further suggest that policymakers harness these methods to sustain patient safety efforts instead of relying on pay-for-performance incentives. A PSNet interview with the study's lead author explores, among other things, how to sustain changes in practice.