About: Reduction of Central Line-associated Bloodstream Infection Through Focus on the Mesosystem: Standardization, Data, and Accountability

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
has title	Reduction of Central Line-associated Bloodstream Infection Through Focus on the Mesosystem: Standardization, Data, and Accountability
Creator	Wood, Matthew Lee, Grace Ferrari, Sarah Taylor, Kristine Donnelly, Lane Bain, Lisa Bargmann-Losche, Jessey Margallo, Dionne Mathew, Roshni Rhein, Michelle Simms, Alison Valencia, Amy
Source	PMC
abstract	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.
has issue date	2020-03-25(xsd:dateTime)
bibo:doi	10.1097/pq9.0000000000000272
bibo:pmid	32426638
has license	cc-by
sha1sum (hex)	8b5c287b712f34a4e6e3fb89582adc36775a3579
schema:url	https://doi.org/10.1097/pq9.0000000000000272
resource representing a document's title	Reduction of Central Line-associated Bloodstream Infection Through Focus on the Mesosystem: Standardization, Data, and Accountability
has PubMed Central identifier	PMC7190265
has PubMed identifier	32426638
schema:publication	Pediatr Qual Saf
resource representing a document's body	covid:8b5c287b712f34a4e6e3fb89582adc36775a3579#body_text
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