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Odada D, Munyi H, Gatuiku J, Thuku R, Nyandigisi J, Wangui A, Ashihundu E, Nyakiringa B, Kimeu J, Musumbi M, Adam RD. Reducing the rate of central line-associated bloodstream infections; a quality improvement project. BMC Infect Dis 2023; 23:745. [PMID: 37904103 PMCID: PMC10617146 DOI: 10.1186/s12879-023-08744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/24/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The burden of central line-associated bloodstream infections is significant and has negative implications for healthcare, increasing morbidity and mortality risks, increasing inpatient hospital stays, and increasing the cost of hospitalization. Efforts to reduce the incidence of central line-associated bloodstream infections have utilized quality improvement projects that implement, measure, and monitor outcomes. However, variations in location, healthcare organization, patient risks, and practice gaps are key to the success of interventions and approaches. This study aims to evaluate interventions of a quality improvement project on the reduction of central line-associated bloodstream infection rates at a university teaching hospital. METHODS This was a retrospective review of a quality improvement project that was implemented using the Plan-Do-Study-Act quality improvement cycle. Active surveillance of processes and outcomes was performed in the critical care areas; compliance to central line care bundles, and central line-associated bloodstream infections. Interrupted time series was used to analyze trends pre and post-intervention and regression modeling to estimate data segments preceding and succeeding the interventions. RESULTS There were 350 central line insertions, 3912 catheter days, and 20 central line-associated bloodstream infection events during the intervention period. Compliance with central line care bundles was at 94%. There was a trend in the reduction of central line-associated bloodstream infections by 18% that did not reach statistical significance (p = 0.252). CONCLUSIONS Improvement projects to reduce central line-associated bloodstream infections face challenges and complexities associated with implementing interventions in real-world healthcare settings. There is a great need to continuously monitor, evaluate, readjust, and adapt interventions to achieve desired results, sustain improvements in patient outcomes, and investigate reasons for non-adherence as keys to achieving desired outcomes.
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Affiliation(s)
- David Odada
- Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya.
| | - Hellen Munyi
- Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya
| | - Japhet Gatuiku
- Department of Pharmacy, Aga Khan University Hospital, Nairobi, Kenya
| | - Ruth Thuku
- Department of Quality, Aga Khan University Hospital, Nairobi, Kenya
| | - Jared Nyandigisi
- Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya
| | - Anne Wangui
- Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya
| | - Emilie Ashihundu
- Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Jemimah Kimeu
- Department of Nursing, Aga Khan University Hospital, Nairobi, Kenya
| | - Martin Musumbi
- Department of Internal Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Rodney D Adam
- Department of Internal Medicine, Aga Khan University Hospital, Nairobi, Kenya
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised Publication Guidelines From a Detailed Consensus Process. J Contin Educ Nurs 2017; 46:501-7. [PMID: 26509402 DOI: 10.3928/00220124-20151020-02] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/17/2015] [Indexed: 11/20/2022]
Abstract
Since the publication of Standards for QUality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semi-structured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of three key components of systematic efforts to improve the quality, value, and safety of healthcare: the use of formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (http://www.squire-statement.org).
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. Am J Med Qual 2017; 30:543-9. [PMID: 26497490 PMCID: PMC4620592 DOI: 10.1177/1062860615605176] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the past several years, the science of health care improvement has advanced considerably. In this article, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes 3 key components of systematic efforts to improve the quality, value, and safety of health care: formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).
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Affiliation(s)
- Greg Ogrinc
- Geisel School of Medicine at Dartmouth, Hanover, NH White River Junction VA, White River Junction, VT The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Louise Davies
- Geisel School of Medicine at Dartmouth, Hanover, NH White River Junction VA, White River Junction, VT The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Daisy Goodman
- Geisel School of Medicine at Dartmouth, Hanover, NH VA Quality Scholars Fellowship Program, Hanover, NH
| | - Paul Batalden
- Geisel School of Medicine at Dartmouth, Hanover, NH The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Frank Davidoff
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - David Stevens
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH Institute for Healthcare Improvement, Cambridge, MA
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SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised Publication Guidelines From a Detailed Consensus Process. J Nurs Care Qual 2016; 31:1-8. [PMID: 26429125 PMCID: PMC5411027 DOI: 10.1097/ncq.0000000000000153] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text.
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised Publication Guidelines from a Detailed Consensus Process. Perm J 2016; 19:65-70. [PMID: 26517437 DOI: 10.7812/tpp/15-141] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Since the publication of Standards for Quality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015, using 1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group; 2) two face-to-face consensus meetings to develop interim drafts; and 3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of three key components of systematic efforts to improve the quality, value, and safety of health care: the use of formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).
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Affiliation(s)
- Greg Ogrinc
- Senior Associate Dean for Medical Education in the Geisel School of Medicine at Dartmouth College; Associate Chief of Staff for Education at the White River Junction Veterans Administration Medical Center, VT; and Associate Professor of Community and Family Medicine, of Medicine, and of The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth College in Hanover, NH.
| | - Louise Davies
- Senior Scholar in the Quality Scholars Program in the Department of Veterans Affairs Medical Center, White River Junction, VT; and Associate Professor of Surgery at the Geisel School of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice in Hanover, NH
| | - Daisy Goodman
- Fellow at the Veterans Administration Quality Scholars Fellowship Program, White River Junction, VT; and an Instructor of Obstetrics and Gynecology and Community and Family Medicine at the Geisel School of Medicine at Dartmouth College in Hanover, NH
| | - Paul Batalden
- Active Emeritus Professor of Pediatrics and Community and Family Medicine at the Geisel School of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice in Hanover, NH
| | - Frank Davidoff
- Editor Emeritus of Annals of Internal Medicine; and an Adjunct Professor at The Dartmouth Institute for Health Policy and Clinical Practice and the Geisel School of Medicine at Dartmouth College in Hanover, NH
| | - David Stevens
- Adjunct Professor at The Dartmouth Institute for Health Policy and Clinical Practice in Hanover, NH; and an Editor Emeritus of BMJ Quality and Safety in London, United Kingdom; and Senior Fellow of the Institute for Healthcare Improvement in Cambridge, MA
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. Can J Diabetes 2016; 39:434-9. [PMID: 26443286 DOI: 10.1016/j.jcjd.2015.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 11/30/2022]
Abstract
Since the publication of Standards for Quality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using 1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group; 2) 2 face-to-face consensus meetings to develop interim drafts and 3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes the reporting of 3 key components of systematic efforts to improve the quality, value and safety of healthcare: the use of formal and informal theory in planning, implementing and evaluating improvement work; the context in which the work is done and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org).
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Affiliation(s)
- Greg Ogrinc
- White River Junction VA Medical Center, White River Junction, Vermont, USA; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA.
| | - Louise Davies
- White River Junction VA Medical Center, White River Junction, Vermont, USA; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Daisy Goodman
- White River Junction VA Medical Center, White River Junction, Vermont, USA; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Paul Batalden
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA; Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
| | - Frank Davidoff
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - David Stevens
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA; Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
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SQUIRE 2.0—Standards for Quality Improvement Reporting Excellence—Revised Publication Guidelines from a Detailed Consensus Process. J Am Coll Surg 2016; 222:317-23. [DOI: 10.1016/j.jamcollsurg.2015.07.456] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 07/27/2015] [Indexed: 11/23/2022]
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. Standards for QUality Improvement Reporting Excellence 2.0: revised publication guidelines from a detailed consensus process. J Surg Res 2016; 200:676-82. [DOI: 10.1016/j.jss.2015.09.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised Publication Guidelines from a Detailed Consensus Process. Jt Comm J Qual Patient Saf 2015; 41:474-9. [DOI: 10.1016/s1553-7250(15)41062-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf 2015; 25:986-992. [PMID: 26369893 PMCID: PMC5256233 DOI: 10.1136/bmjqs-2015-004411] [Citation(s) in RCA: 1467] [Impact Index Per Article: 163.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/11/2015] [Accepted: 07/17/2015] [Indexed: 11/17/2022]
Abstract
Since the publication of Standards for QUality Improvement Reporting Excellence (SQUIRE 1.0) guidelines in 2008, the science of the field has advanced considerably. In this manuscript, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) semistructured interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) two face-to-face consensus meetings to develop interim drafts and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasises the reporting of three key components of systematic efforts to improve the quality, value and safety of healthcare: the use of formal and informal theory in planning, implementing and evaluating improvement work; the context in which the work is done and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve healthcare, recognising that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (http://www.squire-statement.org).
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Affiliation(s)
- Greg Ogrinc
- White River Junction VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Louise Davies
- White River Junction VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Daisy Goodman
- White River Junction VA Medical Center, White River Junction, Vermont, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Paul Batalden
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Frank Davidoff
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - David Stevens
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA.,Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
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