Nursing leadership at the crossroads: evidence-based practice 'Matching Michigan-minimizing catheter related blood stream infections'(*)

Christine A Goeschel
Nursing in Critical Care 2011, 16 (1): 36-43

AIMS AND OBJECTIVES: a highly successful intervention to reduce infections in intensive care units (ICUs) is now being widely replicated and involved significant nursing leadership. The objective of this manuscript is to describe briefly the intervention, and more explicitly the implications for nursing leadership as quality improvement and patient safety become global healthcare priorities.

DESIGN: collaborative cohort study in over 100 ICUs in the United States to implement and evaluate interventions to improve patients' safety.

METHODS: 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.

RESULTS: one hundred and three ICUs contributed 1981 ICU-months of data representing 375,757 catheter-days. The median rate of catheter-related bloodstream infection per 1000 catheter-days decreased from 2.7 infections at baseline to 0 at 3 months after implementation of the study intervention (P ≤ 0·002), and the mean rate per 1000 catheter-days decreased from 7.7 at baseline to 1.4 at 16-18 months of follow-up (P < 0·002). During the sustainability period, the mean bloodstream infection rate did not significantly change from the initial 18 month postimplementation period (-1%, 95% confidence interval -9% to 7%). Eighty seven percent of the original study participants had data available for the sustainability study.

CONCLUSIONS: broad use of this intervention with achievement of similar results could substantially reduce the morbidity and costs associated with catheter-related bloodstream infections.

RELEVANCE TO CLINICAL PRACTICE: the initial Michigan study and the follow-up analysis, that demonstrated sustained improvements, are leading to similar projects in other countries, include the Matching Michigan project in England. Discussing not only the technical components of the program, but also the nursing leadership aspects may assist nurses just embarking on this work.

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