Central venous catheterization is one of the most widely used invasive procedures, and it significantly increases the risk for infection. Sustained reduction of central line-associated bloodstream infection (CLABSI) remains elusive in many institutions despite increased awareness of evidence-based preventive strategies, publication of successful hospital CLABSI elimination programs, and elimination of reimbursement for the cost of treating CLABSIs. A March 2009 Centers for Disease Control and Prevention report estimates the cost of one CLABSI in 2007 U.S. dollars to be $29,156, which totals $2.68 billion in excess costs annually. A study by Klevens et al. found that of the 98,987 patient deaths caused by or associated with healthcare-associated infections in 2002, 31% of those cases were attributed to bloodstream infections. Pennsylvania hospitals answer questions in each CLABSI report submitted to the National Healthcare Safety Network indicating compliance with three evidence-based practices including use of maximal sterile barriers, chlorhexidine site preparation, and documentation of review of daily necessity for continuation of the central line. The Pennsylvania Patient Safety Authority's analysis of CLABSI event reports from July 2008 through March 2009 concludes that while Pennsylvania's CLABSI and central line utilization rates are significantly better than the national average, hospitals documented unknown compliance with evidence-based best practices for CLABSI prevention in an average of 38% of events reported. Hospitals with the lowest CLABSI rates reported twice the use of all three practices than hospitals with the highest rates of infection. The key to achieving sustainable, actionable CLABSI reduction is to combine adaptive cultural changes with evidence-based practices and a renewed focus from hospital leaders and clinicians on a culture of safety.
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