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Reduction of Central Line-associated Bloodstream Infection Through Focus on the Mesosystem: Standardization, Data,
Roshni Mathew1, Alison Simms2, Matthew Wood2
1Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif.
Introduction:
Efforts to reduce central line-associated bloodstream infection (CLABSI) rates require strong microsystems for success. However, variation in practices across units leads to challenges in ensuring accountability. We redesigned the organization's mesosystem to provide oversight and alignment of microsystem efforts and ensure accountability in the context of the macrosystem. We implemented an A3 framework to achieve reductions in CLABSI through adherence to known evidence-based bundles.
Methods:
We conducted this CLABSI reduction improvement initiative at a 395-bed freestanding, academic, university-affiliated children's hospital. A mesosystem-focused A3 emphasized bundle adherence through 3 key drivers (1) practice standardization, (2) data transparency, and (3) accountability. We evaluated the impact of this intervention on CLABSI rates during the pre-intervention (01/15-09/17) and post-intervention (07/18-06/19) periods using a Poisson model controlling for baseline trends.
Results:
Our quarterly CLABSI rates during the pre-intervention period ranged from 1.0 to 2.3 CLABSIs per 1,000 central line-days. With the mesosystem in place, CLABSI rates ranged from 0.4 to 0.7 per 1,000 central line days during the post-intervention period. Adjusting for secular trends, we observed a statistically significant decrease in the post versus pre-intervention CLABSI rate of 71%.
Conclusion:
Our hospital-wide CLABSI rate declined for the first time in many years after the redesign of the mesosystem and a focus on practice standardization, data transparency, and accountability. Our approach highlights the importance of alignment across unit-level microsystems to ensure high-fidelity implementation of practice standards throughout the healthcare-delivery system.
Insights
Implementing a redesigned mesosystem and A3 framework significantly reduced central line-associated bloodstream infection (CLABSI) rates by 71%. This initiative improved practice standardization, data transparency, and accountability, leading to sustained CLABSI reductions.
Area of Science:
- Healthcare Improvement Science
- Patient Safety
- Infection Prevention
Background:
- Reducing central line-associated bloodstream infections (CLABSI) is critical but challenging due to practice variations.
- A redesigned mesosystem provides oversight and alignment for unit-level microsystems.
- An A3 framework was implemented to standardize practices and improve accountability.
Purpose of the Study:
- To evaluate the impact of a mesosystem redesign and A3 framework on CLABSI rates.
- To assess the effectiveness of practice standardization, data transparency, and accountability in reducing CLABSIs.
- To demonstrate sustained CLABSI reduction through improved system-level alignment.
Main Methods:
- A quasi-experimental study was conducted at a children's hospital.
- A mesosystem-focused A3 framework drove the initiative, emphasizing bundle adherence.
- CLABSI rates were compared pre-intervention (Jan 2015-Sep 2017) and post-intervention (Jul 2018-Jun 2019) using Poisson regression.
Main Results:
- Pre-intervention CLABSI rates ranged from 1.0 to 2.3 per 1,000 central line-days.
- Post-intervention CLABSI rates decreased to a range of 0.4 to 0.7 per 1,000 central line-days.
- A statistically significant 71% reduction in CLABSI rates was observed post-intervention, adjusted for trends.
Conclusions:
- Redesigning the mesosystem and focusing on standardization, transparency, and accountability led to a significant hospital-wide CLABSI rate decline.
- This approach achieved sustained CLABSI reduction for the first time in years.
- Alignment across microsystems is crucial for high-fidelity implementation of practice standards in healthcare delivery.
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