The CLABs Collaborative: A Regionwide Effort to Improve the Quality of Care in Hospitals

Background: Each year, nearly 250,000 cases of central line-associated bloodstream infections (CLABs) occur in hospitals in the United States. In 2005, the Greater New York Hospital Association and the United Hospital Fund launched a collaborative initiative to eliminate CLABs in hospital intensive care units (ICUs). Collaborative Design: Hospital leadership at 36 hospitals committed to support their staffs' participation in specific activities, including three learning sessions. An infectious disease physician consultant served as an on-call consultant to provide the necessary clinical guidance, real-time feedback, and support. Most hospitals' interdisciplinary CLABs teams met weekly to implement evidence-based practices known collectively as the central line bundle, determine areas for additional focus, and to reassess strategies using the Plan-Do-Study-Act (PDSA) model. Results: There was a statistically significant decrease of 54% (p <.001) between the mean CLABs rate during the intervention period (2.24 infections per 1,000 central line days) compared with the mean baseline rate (4.85 infections per 1,000 central line days). By March 2008, the rate had dropped by 70% (1.44 infections per 1,000 central line days) compared with baseline. At the hospital level, decreases in CLABs rates up to 88% were observed between the baseline period and the intervention period, with 56% of hospitals achieving at least a 50% decrease in their CLABs rate. The hospitals beginning above the national rate decreased their CLABs rates by almost twice as much as hospitals that began below the national average. Summary and Conclusions: Each participating hospital sustained implementation of the central line bundle throughout the 33-month intervention, which, along with standardized line maintenance procedures, resulted in reduction in, and sometimes elimination of, CLABs.