Catheter related bloodstream infections cause considerable morbidity, mortality, and healthcare costs. The Michigan Health & Hospital Association (MHA) Keystone ICU project in the US is an ongoing quality improvement project, which reduced these infections in 103 participating intensive care units (ICUs). The median infection rate per 1000 catheter days dropped from 2.7 at baseline to 0 within 3 months after implementation of an evidence-based intervention, and 18 months after implementation, infection rates had decreased by 66% from baseline. In this study, researchers evaluated the extent to which participating ICUs were able to sustain these reduced rates of catheter related bloodstream infection.

The intervention was a conceptual model aimed at improving clinicians’ use of five evidence based recommendations to reduce rates of catheter related bloodstream infections rates, with measurement and feedback of infection rates. During the sustainability period, ICU teams were instructed to integrate this intervention into staff orientation, collect monthly data from hospital infection control staff, and report infection rates to appropriate stakeholders. The main outcome measure was the quarterly rate of catheter related bloodstream infections per 1000 catheter days during the sustainability period (19 to 36 months after implementation of intervention).

The following data were reported for 90 (87%) of the original 103 participating intensive care units, reporting 1532 intensive care unit months of data and 300,310 catheter days during the sustainability period:

• Mean and median rates of catheter related bloodstream infection decreased from 7.7 and 2.7 at baseline to 1.3 and 0 at 16-18 months, and to 1.1 and 0 at 34-36 months post-implementation.

• Incidence rate ratios decreased from 0.68 (95% CI 0.53 to 0.88) at 0-3 months to 0.38 at 16-18 months and 0.34 at 34-36 months post-implementation.

• During the sustainability period, the mean bloodstream infection rate did not significantly change from the initial 18 month post-implementation period (–1%, 95% CI, –9% to 7%).

The researchers conclude that a multifaceted quality improvement project can sustain reductions in bloodstream infection rates to 36 months post-implementation and suggest that broad use of this intervention with achievement of similar results could substantially reduce morbidity and costs associated with such infections.