Assessment of the Reported Effectiveness of Five Different Quality- Improvement Initiatives for the Prevention of Central Line-Associated Bloodstream Infections in Intensive Care Units

Lawrence F. Muscarella*
Custom Ultrasonics, Inc., 144 Railroad Drive, Ivyland, PA 18974, USA.

© 2012F. Muscarella et al..

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Custom Ultrasonics, Inc., 144 Railroad Drive, Ivyland, PA 18974,USA; Tel: 215-364-8577; E-mail:


Five studies that evaluated five different quality-improvement initiatives for the prevention of central line-associated bloodstream infections (CLABSIs) in adult, pediatric and/or neonatal intensive care units (ICUs) and that were published within the past two years in an infection-control and epidemiology journal were reviewed, assessed and compared. Each is a prospective cohort study that similarly concludes that the evaluated initiative was responsible for a significant and calculated reduction in the CLABSI rate, ranging from 30.3% to 85%. The soundness of these conclusions and calculations, however, like the legitimacy of several other common uses of CLABSI data, requires, in addition to satisfying a number of other criteria, that each study's CLABSI rates be accurate and complete. The primary goal of this analysis, therefore, was to confirm the hypothesis that each of these five studies had validated its CLABSI rates. The analysis found, however, that these five studies did not validate the accuracy and completeness of their CLABSI rates, which raises reasonable questions about each study’s assessment of and conclusions about the initiative's effectiveness for the prevention of CLABSIs. In addition to their aims, calculations, and conclusions, these five studies share in common a number of features, as well as circumscribing qualities, which are discussed. The distinction between a qualitative assessment and a quantitative determination of an initiative's performance is also discussed. Both the circumspective use of CLABSI data that have not been validated and the cautious interpretation of conclusions about central-line care that are based on these CLABSI data are recommended.

Keywords: Central line-associated bloodstream infections, central lines, quality-improvement initiatives, prospective-cohortstudies, confounding factors, biases, performance feedback, compliance data, data validation, outcome surveillance, process surveillance.