Our Accomplishments

Addressing Central-Line Bloodstream Infections


The South Carolina Healthcare Quality Trust, made possible by The Duke Endowment, was formed in February 2009. The Trust determined that addressing central-line bloodstream infections (CLABSI) was its initial priority due to achievability, high mortality and cost. (The CDC estimates that 30,000 to 60,000+ people die from CLABSI in the United States each year).

Key stakeholders of the Trust formed a hospital-acquired infection (HAI) committee composed of infection prevention registered nurses and hospital physician epidemiologists from HSSC’s four major health care systems, university partner investigators from the colleges of medicine, pharmacy, public health, and nursing), the South Carolina Hospital Association (SCHA), the South Carolina Department of Health and Environmental Control, and Premier, Inc. The research study was funded by HSSC with Premier collecting and analyzing clinical and financial data from the hospitals and facilitating identification of best practices to improve patient outcome.

Premier’s baseline data for the period of October 2007 through September 2008 indicated there were 437 cases of CLABSI in the four HSSC health systems. The average rate of CLABSI as a percentage of total patients with central line insertions was 6.56 percent.

The stakeholders aligned efforts to address reduction of CLABSI. Spearheaded by SCHA, 21 South Carolina hospitals enrolled in the second cohort of a multi-state learning collaborative program led by the Johns Hopkins Research Group, “On the Cusp: Stop BSI,” to implement evidence-based protocols related to 1) establishing a culture of safety; 2) central-line insertion; and 3) central-line maintenance. All HSSC partner hospitals are participants and thus far in South Carolina, the program has been implemented in 21 hospitals with 46 ICU and non-ICU care teams participating.

HSSC extramural program officer Janet Craig says that as a result of this collective effort, significant reductions in CLABSI have been observed compared with the baseline figures. For example, the year after baseline data was gathered, the Premier database indicated that the number of patients with CLABSI was 191, or 1.3 percent of central line insertions, which translates to a 56 percent reduction and 246 fewer patients who experienced harm caused by this hospital-acquired infection. A similar reduction was observed for HSSC member hospitals, for which critical care CLABSI occurrences per 1,000 central-line days (the method used by the CDC to calculate rates) dropped from 4.6 to 1.8. For the 21 hospitals participating in the “Stop BSI” program, the CLABSI rate per 1,000 central-line days dropped from 2.2 to 2.5, which represents a 31 percent improvement. The risk-adjusted mortality for CLABSI in HSSC hospitals now compares well to samples of all U.S. hospitals in Premier’s database.

During the past year HAI committee investigators from the USC College of Pharmacy completed an investigation of the risk factors associated with CLABSI in hospitals nationwide compared to South Carolina using Premier’s database of 600-plus hospitals. The sample of 1.4 million discharges nationally, and 57,653 discharged in South Carolina, covered a five-year period through 2008 and included both ICU and non-ICU patients.

The findings indicated:

  • CLABSI rates are as high outside of the ICU as they are inside.
  • Patients’ risk of dying increases significantly with CLABSI as does their cost of care.
  • South Carolina’s occurrence rate through 2008 was slightly lower than the national rate, but mortality and cost were greater.
  • Patient-specific risk factors include age, sex, length of catheterization, number of procedures, and duration of hospital stay.

The research, which was updated through 2010 to reflect the multiple national efforts to eliminate CLABSI, was accepted for presentation by Dana Stafkey-Mailey, PhD, of the USC College of Pharmacy at the Society for Healthcare Epidemiology of America (SHEA) 2011 Annual Scientific Meeting.

As the result of HSSC’s efforts, South Carolina clinicians and investigators experienced multiple opportunities to participate in national research projects aimed at eliminating healthcare associated infections.