'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England

Julian Bion; Annette Richardson; Peter Hibbert; Jeanette Beer; Tracy Abrusci; Martin McCutcheon; Jane Cassidy; Jane Eddleston; Kevin Gunning; Geoff Bellingan; Mark Patten; David Harrison; Matching Michigan Collaboration & Writing Committee

doi:10.1136/bmjqs-2012-001325

'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England

Julian Bion, Annette Richardson, Peter Hibbert, Jeanette Beer, Tracy Abrusci, Martin McCutcheon, Jane Cassidy, Jane Eddleston, Kevin Gunning, Geoff Bellingan, Mark Patten, David Harrison, Matching Michigan Collaboration & Writing Committee

Research output: Contribution to journal › Article › peer-review

186 Citations (Scopus)

Abstract

BACKGROUND: Bloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions.

METHODS: We conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification.

RESULTS: Of 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (κ 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely.

CONCLUSIONS: The marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care.

Original language	English
Pages (from-to)	110-23
Number of pages	14
Journal	BMJ Quality & Safety
Volume	22
Issue number	2
DOIs	https://doi.org/10.1136/bmjqs-2012-001325
Publication status	Published - Feb 2013

Keywords

Adult
Benchmarking
Catheter-Related Infections
Catheterization, Central Venous
Child
Cluster Analysis
Cross Infection
England
Humans
Infection Control
Inservice Training
Intensive Care Units
Intensive Care Units, Pediatric
Length of Stay
Longitudinal Studies
Patient Care Team
Poisson Distribution
Prospective Studies
Regression Analysis

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10.1136/bmjqs-2012-001325Licence: Creative Commons: Attribution-NonCommercial (CC BY-NC)

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Bion, J., Richardson, A., Hibbert, P., Beer, J., Abrusci, T., McCutcheon, M., Cassidy, J., Eddleston, J., Gunning, K., Bellingan, G., Patten, M., Harrison, D., & Matching Michigan Collaboration & Writing Committee (2013). 'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England. BMJ Quality & Safety, 22(2), 110-23. https://doi.org/10.1136/bmjqs-2012-001325

@article{09a61b8dcf00487a949245db93fa985c,

title = "'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England",

abstract = "BACKGROUND: Bloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions.METHODS: We conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification.RESULTS: Of 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (κ 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely.CONCLUSIONS: The marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care.",

keywords = "Adult, Benchmarking, Catheter-Related Infections, Catheterization, Central Venous, Child, Cluster Analysis, Cross Infection, England, Humans, Infection Control, Inservice Training, Intensive Care Units, Intensive Care Units, Pediatric, Length of Stay, Longitudinal Studies, Patient Care Team, Poisson Distribution, Prospective Studies, Regression Analysis",

author = "Julian Bion and Annette Richardson and Peter Hibbert and Jeanette Beer and Tracy Abrusci and Martin McCutcheon and Jane Cassidy and Jane Eddleston and Kevin Gunning and Geoff Bellingan and Mark Patten and David Harrison and {Matching Michigan Collaboration & Writing Committee}",

year = "2013",

month = feb,

doi = "10.1136/bmjqs-2012-001325",

language = "English",

volume = "22",

pages = "110--23",

journal = "BMJ Quality & Safety",

issn = "2044-5415",

publisher = "BMJ Publishing Group",

number = "2",

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Bion, J, Richardson, A, Hibbert, P, Beer, J, Abrusci, T, McCutcheon, M, Cassidy, J, Eddleston, J, Gunning, K, Bellingan, G, Patten, M, Harrison, D & Matching Michigan Collaboration & Writing Committee 2013, ''Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England', BMJ Quality & Safety, vol. 22, no. 2, pp. 110-23. https://doi.org/10.1136/bmjqs-2012-001325

TY - JOUR

T1 - 'Matching Michigan'

T2 - a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England

AU - Bion, Julian

AU - Richardson, Annette

AU - Hibbert, Peter

AU - Beer, Jeanette

AU - Abrusci, Tracy

AU - McCutcheon, Martin

AU - Cassidy, Jane

AU - Eddleston, Jane

AU - Gunning, Kevin

AU - Bellingan, Geoff

AU - Patten, Mark

AU - Harrison, David

AU - Matching Michigan Collaboration & Writing Committee

PY - 2013/2

Y1 - 2013/2

N2 - BACKGROUND: Bloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions.METHODS: We conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification.RESULTS: Of 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (κ 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely.CONCLUSIONS: The marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care.

AB - BACKGROUND: Bloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions.METHODS: We conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification.RESULTS: Of 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (κ 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely.CONCLUSIONS: The marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care.

KW - Adult

KW - Benchmarking

KW - Catheter-Related Infections

KW - Catheterization, Central Venous

KW - Child

KW - Cluster Analysis

KW - Cross Infection

KW - England

KW - Humans

KW - Infection Control

KW - Inservice Training

KW - Intensive Care Units

KW - Intensive Care Units, Pediatric

KW - Length of Stay

KW - Longitudinal Studies

KW - Patient Care Team

KW - Poisson Distribution

KW - Prospective Studies

KW - Regression Analysis

U2 - 10.1136/bmjqs-2012-001325

DO - 10.1136/bmjqs-2012-001325

M3 - Article

C2 - 22996571

SN - 2044-5415

VL - 22

SP - 110

EP - 123

JO - BMJ Quality & Safety

JF - BMJ Quality & Safety

IS - 2

ER -

'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England

Abstract

Keywords

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