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Invited Critique
March 21, 2011

Improving Outcomes: The Importance of Data Monitoring and Ongoing Educational Interventions: Comment on “Trends in Central Line–Associated Bloodstream Infections in a Trauma-Surgical Intensive Care Unit”

Author Affiliations

Author Affiliation: Departments of Surgery, University of Utah and Huntsman Cancer Hospital, Salt Lake City.

Arch Surg. 2011;146(3):307. doi:10.1001/archsurg.2011.10

In their report, Ong et al present a detailed account of how they in essence have developed a “best practice” for central line insertion and care in their surgical critical unit. With these data, the authors elegantly display the effect of the interventions as their central line–associated infection rate dropped to near zero, and they have been successful in maintaining this for 2½ years. There are several written and unwritten take-home points. First, looking at data specific to you and your institution is of utmost importance. This in and of itself is sometimes enough to improve outcomes. Second, comparing your outcomes with national data will allow interventions where they are needed. Third, Ong et al developed and implemented an evidence-based educational intervention that included standardization of their protocols. Fourth, they have ongoing educational interventions along with mentoring by qualified personnel to help maintain their gain (or, in this case, loss/reduction of catheter-related infections). Their report is sufficiently detailed in the processes that any institution could replicate the experiment and should obtain similar results. In addition, they recognized by comparing their results against national data that their rate of central line utilization is higher than most, and this will likely be the target of their next intervention.

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