National Healthcare Safety Network Data Research Articles

Health care–associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration

This case study is part of a series centered on the Centers for Disease Control and Prevention's National Healthcare Safety Network's (NHSN) health care-associated infection (HAI) surveillance definitions. The intent of the case study series is to foster standardized application of the NHSN's HAI surveillance definitions among infection preventionists and accurate determination of HAI events. This specific case study focuses on the definitions found within the surgical site infection (SSI) protocol. It aims to reflect the real life and complex patient scenario surrounding a bloodstream infection that is secondary to an SSI and the application of the Present at the Time of Surgery event detail. An online survey link is provided where participants may confidentially answer questions related to the case study and receive immediate feedback in the form of correct answers and explanations and rationales. Details of the case study, answers, and explanations have been reviewed and approved by NHSN staff. We hope that participants take advantage of this educational offering and thereby gain a greater understanding of the NHSN's HAI surveillance definitions.

Truth in Reporting: How Data Capture Methods Obfuscate Actual Surgical Site Infection Rates within a Health Care Network System.

Two systems measure surgical site infection rates following colorectal surgeries: the American College of Surgeons National Surgical Quality Improvement Program and the Centers for Disease Control and Prevention National Healthcare Safety Network. The Centers for Medicare & Medicaid Services pay-for-performance initiatives use National Healthcare Safety Network data for hospital comparisons. This study aimed to compare database concordance. This is a multi-institution cohort study of systemwide Colorectal Surgery Collaborative. The National Surgical Quality Improvement Program requires rigorous, standardized data capture techniques; National Healthcare Safety Network allows 5 data capture techniques. Standardized surgical site infection rates were compared between databases. The Cohen κ-coefficient was calculated. This study was conducted at Boston-area hospitals. National Healthcare Safety Network or National Surgical Quality Improvement Program patients undergoing colorectal surgery were included. Standardized surgical site infection rates were the primary outcomes of interest. Thirty-day surgical site infection rates of 3547 (National Surgical Quality Improvement Program) vs 5179 (National Healthcare Safety Network) colorectal procedures (2012-2014). Discrepancies appeared: National Surgical Quality Improvement Program database of hospital 1 (N = 1480 patients) routinely found surgical site infection rates of approximately 10%, routinely deemed rate "exemplary" or "as expected" (100%). National Healthcare Safety Network data from the same hospital and time period (N = 1881) revealed a similar overall surgical site infection rate (10%), but standardized rates were deemed "worse than national average" 80% of the time. Overall, hospitals using less rigorous capture methods had improved surgical site infection rates for National Healthcare Safety Network compared with standardized National Surgical Quality Improvement Program reports. The correlation coefficient between standardized infection rates was 0.03 (p = 0.88). During 25 site-time period observations, National Surgical Quality Improvement Program and National Healthcare Safety Network data matched for 52% of observations (13/25). κ = 0.10 (95% CI, -0.1366 to 0.3402; p = 0.403), indicating poor agreement. This study investigated hospitals located in the Northeastern United States only. Variation in Centers for Medicare & Medicaid Services-mandated National Healthcare Safety Network infection surveillance methodology leads to unreliable results, which is apparent when these results are compared with standardized data. High-quality data would improve care quality and compare outcomes among institutions.

The Relationship Between Payer and Risk of Surgical Site Infection Following Cesarean Delivery

BackgroundBoth Medicaid and private health insurance support important access to care for many pregnant women in the United States. The role of health insurance on many outcomes, such as surgical site infection (SSI) following Cesarean delivery (CD), has not been adequately investigated.MethodsThis retrospective cohort study investigated SSI risk following CDs performed in California hospitals in 2011 among women covered by Medicaid or private health insurance. All CDs were obtained from identifiable state inpatient discharge (SID) data and linked with National Healthcare Safety Network (NHSN) data to ascertain post-delivery SSI. Characteristics including age, race/ethnicity, BMI, prior CD planned admission, emergency CD, active labor and labor duration, ASA physical status, general anesthesia, wound class, hospital ownership, hospital annual CD count, intern/resident-to-bed ratio, case mix index, disproportionate share adjustment, urban location, and area wage index were obtained from CMS facility, NHSN, and SID data. Potential effect modification of the payer-SSI relationship was assessed using a multivariable logistic regression model.Results90% of eligible NHSN records linked with a SID record. The analytic dataset consisted of 387 SSIs following 57,143 CDs performed in 196 hospitals. Payer distribution across CDs was 49% Medicaid, 51% private insurer. SSIs were reported following 0.74% of CDs among Medicaid recipients and 0.62% among those privately insured (unadjusted risk ratio: 1.2, 95% confidence interval: 1.0–1.5, P = 0.09). In for-profit hospitals women with Medicaid had a 2.6-fold (95% CI: 1.2–5.4, P = 0.01) increase in adjusted SSI risk compared with women with private insurance. There were no differences in adjusted SSI risk by payer in government (RR: 1.1, 95% CI 0.7–1.8, P = 0.92) or not-for-profit hospitals (RR: 0.9, 95% CI 0.7–1.2, P = 0.52).ConclusionDespite accounting for various patient and facility-level factors, Medicaid-insured women experienced higher SSI risk than privately-insured women in for-profit hospitals, but not in government owned or not-for-profit hospitals. Additional studies to understand underlying causes may help target efforts to prevent SSIs following CDs among vulnerable patients.Disclosures All authors: No reported disclosures.

Improving Prediction Accuracy of "Central Line-Associated Blood Stream Infections" Using Data Mining Models.

Prediction of nosocomial infections among patients is an important part of clinical surveillance programs to enable the related personnel to take preventive actions in advance. Designing a clinical surveillance program with capability of predicting nosocomial infections is a challenging task due to several reasons, including high dimensionality of medical data, heterogenous data representation, and special knowledge required to extract patterns for prediction. In this paper, we present details of six data mining methods implemented using cross industry standard process for data mining to predict central line-associated blood stream infections. For our study, we selected datasets of healthcare-associated infections from US National Healthcare Safety Network and consumer survey data from Hospital Consumer Assessment of Healthcare Providers and Systems. Our experiments show that central line-associated blood stream infections (CLABSIs) can be successfully predicted using AdaBoost method with an accuracy up to 89.7%. This will help in implementing effective clinical surveillance programs for infection control, as well as improving the accuracy detection of CLABSIs. Also, this reduces patients' hospital stay cost and maintains patients' safety.

Reducing blood stream infection in patients on hemodialysis: Incorporating patient engagement into a quality improvement activity.

Introduction Infection in our immunocompromised patients is the second leading cause of death, according to the Centers for Disease Control and Prevention (CDC). In an effort to improve quality of care, engage patients in their own care, and reduce morbidity and mortality secondary to infection, the Network designed a joint quality improvement/patient engagement activity to decrease bloodstream infection (BSI) rates. Methods Dialysis facilities were ranked utilizing 2014 National Healthcare Safety Network (NHSN) data. Selection included 20% of Network 13 facilities (n = 58) with the highest BSI rates, which captured 31% of the patient population. Findings Statistically significant (P < 0.001) improvement was reached in the reduction of BSIs; increasing patient engagement in the infection control process; and, correct completion of hand hygiene audits. Significant (P < 0.01) improvement was reached in correct completion of cannulation audits. There was also improvement in the catheter audits, but results were not significant. Discussion Involving patients in the infection control process contributed to our successful outcomes and could be replicated to meet the needs of the end stage renal disease community as a whole.

Effect of Hand Antisepsis Agent Selection and Population Characteristics on Surgical Site Infection Pathogens.

Selection of a pre-operative hand antisepsis agent has not been studied in relation to surgical site infection (SSI) culture data. In our hospital, we introduced an alcohol-based hand rub (ABR) in 2012 as an alternative to traditional aqueous surgical scrubs (TSS). It was the goal of this study to review any effect of this implementation on SSI pathogen characteristics. In addition, we sought to compare our SSI culture data with available National Healthcare Safety Network (NHSN) data. We hypothesized that SSI pathogens and resistant isolates are affected by surgical hand antisepsis technique. Data collected prospectively between 2007 and 2014 were retrospectively analyzed for two time periods at the Veterans Affairs Boston Healthcare System (VABHS): Before ABR implementation (TSS group) and after (ABR group). Pathogen distribution and pathogenic isolate resistance profiles were compared for TSS and ABR, and similar comparisons, along with procedure-associated SSI comparisons, were made between VABHS and NHSN. All VABHS data were interpreted and categorized according to NHSN definitions. Compared with TSS (n = 4,051), ABR (n = 2,293) had a greater rate of Staphylococcus aureus (42.6% vs. 38.0%), Escherichia coli (12.8% vs. 9.9%), Pseudomonas aeruginosa (8.5% vs. 2.8%), and Enterobacter spp. (10.6% vs. 2.8%), and a lower rate of Klebsiella pneumoniae/K. oxytoca (4.3% vs. 8.5%) cultured from superficial and deep SSIs (p < 0.05). Of the S. aureus isolates, 35.0% and 44.4% were resistant to oxacillin/methicillin (MRSA) in ABR and TSS, respectively (p = 0.06). Looking at all SSIs, coagulase-negative staphylococci and K. pneumoniae/K. oxytoca at VABHS (4.0% and 10.4%, respectively) accounted for the biggest difference from NHSN (11.7% and 4.0%, respectively). Aside from MRSA, where there was no difference between VABHS and NHSN (42.9% vs. 43.7%, respectively; p = 0.87), statistically significant (p < 0.05) differences were observed among multi-drug-resistant K. pneumoniae/K. oxytoca (0% vs. 6.8%, respectively) and Escherichia coli (10.0% vs. 1.6%, respectively), as well as among extended-spectrum cephalosporin-resistant K. pneumoniae/K. oxytoca (4.8% vs. 13.2%, respectively) and Enterobacter (58.3% vs. 27.7%, respectively). VABHS had a greater proportion of SSIs in abdominal and vascular cases than did NHSN (48.6% vs. 22.5% and 13.2% vs. 1.5%, respectively). Overall, these differences were significant (p < 0.05). The TSS and ABR groups differed in the distribution of pathogens recovered. Those differences, along with SSI pathogen distribution, pathogenic isolate resistance profiles, and procedure-associated SSIs between VABHS and NHSN, warrant further investigation.

Health care-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration 2016 Case #1

Health care-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration 2016 Case #1

Active surveillance of hospital-acquired infections in South Africa: Implementation, impact and challenges.

Hospital-acquired infections (HAIs) are a significant although unquantified burden in South Africa. Lack of adequate surveillance compounds this problem. To report on the establishment and outcomes of a unit-specific surveillance system for hospital-acquired infections, based on international standards, in a private academic hospital. Active unit-specific surveillance of device-associated infections (DAIs) was introduced over a 2-year period. The surveillance system was based on the US National Healthcare Safety Network (NHSN) utilising standardised definitions. Analysis of DAI rates and device utilisation was done according to Centers for Disease Control and Prevention methods. Comparative analysis using study-derived annualised data and existing NHSN data was done. Surveillance results of DAI rates showed significant reductions in intensive care unit-related ventilator-associated pneumonia (42%) and central line-associated bloodstream infections (100%) over a 3-year period. Substantial variations in DAI rates and utilisation ratios between wards highlight the importance of unit-specific surveillance. Active surveillance requires a significant investment in resources and is a sustained operational challenge, although equally significant benefits are derived from a better understanding of HAIs with more targeted interventions and efficient use of resources. A robust surveillance system is an essential component of any healthcare infection prevention and control programme and is a prerequisite to contextualising the HAI burden of hospitals.

Improving Outcomes in Elective Colorectal Surgery: A Single-institution Retrospective Review

Our hospital, a Tennessee Surgical Quality Collaborative (TSQC) member, adopted a statewide colorectal care bundle intended to reduce surgical site infections (SSI) in elective colorectal cases. The bundle includes proper antibiotics/dosing, normoglycemia, normothermia, supplemental oxygen six hours postoperatively, and early enteral nutrition. A single-institution retrospective study of our National Surgical Quality Improvement Program (NSQIP) database for the rates of SSI before and after the colorectal bundle. We compared our SSI rates to TSQC hospitals as well as NSQIP datasets. Because of low case numbers in the NSQIP data, National Healthcare Safety Network (NHSN) data collected at our institution was used to compare our colorectal SSI before and after our colorectal bundle. From January 2010 to December 2011, 188 patients underwent nonemergent colorectal surgery in the NSQIP data. Of these, 5.4 per cent (10/188) developed superficial SSIs. During this same time, the rate of the TSQC superficial SSI was 7.1 per cent and NSQIP was 7.8 per cent. From January 2013 to October 2014, after the colorectal bundle started, 76 patients in NSQIP underwent nonemergent colorectal surgery. Of these, 6.5 per cent (5/76) developed superficial SSI, compared with 5.5 per cent in TSQC and 5.5 per cent in NSQIP. NHSN data showed a prebundle rate of 11 per cent and a postbundle rate of 3.5 per cent (P < 00.1, χ(2)). After adopting a colorectal bundle aimed at reducing SSIs, we did not improve our SSI rates in NSQIP; however, our NHSN data demonstrated considerable improvement. Differences in data collection may affect SSI rates, and ultimately "quality" based reimbursement. Implementation of the bundle did improve outcomes in colorectal surgery.

Dialysis Event Surveillance Report: National Healthcare Safety Network data summary, January 2007 through April 2011

A total of 24,092 adverse events in hemodialysis outpatients during January 2007 through April 2011 were reported to the National Healthcare Safety Network. Of 2,656 bloodstream infections, 67.3% were in patients with central venous catheters. For all events, rates associated with central venous catheters were higher than for other vascular access types.

Evaluating the Use of the Case Mix Index for Risk Adjustment of Healthcare-Associated Infection Data: An Illustration using Clostridium difficile Infection Data from the National Healthcare Safety Network

BACKGROUND Case mix index (CMI) has been used as a facility-level indicator of patient disease severity. We sought to evaluate the potential for CMI to be used for risk adjustment of National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) data. METHODS NHSN facility-wide laboratory-identified Clostridium difficile infection event data from 2012 were merged with the fiscal year 2012 Inpatient Prospective Payment System (IPPS) Impact file by CMS certification number (CCN) to obtain a CMI value for hospitals reporting to NHSN. Negative binomial regression was used to evaluate whether CMI was significantly associated with healthcare facility-onset (HO) CDI in univariate and multivariate analysis. RESULTS Among 1,468 acute care hospitals reporting CDI data to NHSN in 2012, 1,429 matched by CCN to a CMI value in the Impact file. CMI (median, 1.49; interquartile range, 1.36-1.66) was a significant predictor of HO CDI in univariate analysis (P<.0001). After controlling for community onset CDI prevalence rate, medical school affiliation, hospital size, and CDI test type use, CMI remained highly significant (P<.0001), with an increase of 0.1 point in CMI associated with a 3.4% increase in the HO CDI incidence rate. CONCLUSIONS CMI was a significant predictor of NHSN HO CDI incidence. Additional work to explore the feasibility of using CMI for risk adjustment of NHSN data is necessary. Infect. Control Hosp. Epidemiol. 2015;37(1):19-25.

Health Care-Associated Infections Studies Project Case #1: A 2015 American Journal of Infection Control and National Healthcare Safety Network data quality collaboration

Health Care-Associated Infections Studies Project Case #1: A 2015 American Journal of Infection Control and National Healthcare Safety Network data quality collaboration

Health Care-Associated Infections Studies Project Case #2: A 2015 American Journal of Infection Control and National Healthcare Safety Network data quality collaboration

Health Care-Associated Infections Studies Project Case #2: A 2015 American Journal of Infection Control and National Healthcare Safety Network data quality collaboration

Reducing Blood Stream Infections (BSIs) in Patients on Hemodialysis (HD)

ON HEMODIALYSIS (HD) Lynda Ball, Cheryl George, Nellie Hedrick, Lynda Osborn, Linda Duval, FMQAI Network 13, Oklahoma City, OK, USA Decreasing infections in the HD patient population is paramount to reduce morbidity and mortality. Network 13 initiated a quality improvement activity (QIA) to reduce BSIs in patients on HD. Key components of this QIA included: Monthly CDC audits; improving communication between patients and staff; and, education. Dialysis facilities were ranked utilizing 2013 National Healthcare Safety Network (NSHN) data. A minimum of 20% of the facilities with the highest BSI rates were chosen to participate. In addition, 20% of the Network 13 patient population (n=3175) was included to ascertain patient engagement in infection control practices. Facilities (n=63) were provided on-line orientation training, a reporting calendar, root cause analysis tools, educational resources (articles, posters, handouts, and on-line training) for patients and staff, CDC infection control audits for monitoring practice, and a patient-engagement checklist. Facilities reported progress monthly. The Network provided technical assistance for adverse reporting or as requested. Facilities were monitored the 2 and 3 quarter of 2014 for monthly BSIs and percentage of hand hygiene, catheter connect/disconnect, and cannulation audits correctly completed. Patient engagement with infection control practices were monitored at baseline, mid-point, and at the completion of the project. Results indicated a statistically significant (p<0.001) improvement in the reduction of BSIs (19.9% to 8.6%), and in increasing patient engagement in the infection control process (81.5% to 92.0%). CDC audits completed correctly included: Hand Hygiene baseline of 75.9% to a final of 92.4% (p<0.001); catheter connect/disconnect baseline of 90.2% to a final of 93.5% (NS); and, cannulation baseline of 78% to a final of 89.1% (p<0.05). The successful outcomes of this QIA suggest that this activity could be replicated and spread to meet the needs of the ESRD community as a whole.

Translating evidence into practice using a systems engineering framework for infection prevention.

The current infection prevention era is defined by the rise of healthcare-associated infections (HAIs) and multidrug-resistant organisms (MDROs). Efforts to combat these and other emerging pathogens have resulted in rapid and ongoing evolution of the contemporary infection prevention environment. Currently, HAIs impose a significant burden on the US healthcare system. Recent analysis of National Healthcare Safety Network data from the early 2000s suggests that at least 1.7 million HAIs occur yearly in US hospitals, associated with at least 99,000 deaths. These numbers have likely increased over the past decade and suggest that HAIs are among the leading causes of death in the United States.

Surveillance of dialysis events: 12-month experience at five outpatient adult hemodialysis centers in Kuwait.

Embedding dialysis surveillance scheme is associated with reductions in blood stream infection and antimicrobial consumption .The aim of this study was to establish baseline dialysis events (DE) rates; hospitalization, intravenous (IV) antibiotics start or a positive blood culture stratified by vascular access category and comparisons to published National Healthcare Safety Network (NHSN) rates. A retrospective review of DE was done between January to December 2012, in five outpatient adult hemodialysis center. The pooled mean rates of hospitalization among patients with fistulas, grafts, permanent and temporary catheters were 2.8, 5.7, 5.1, and 10.6 per 100 patient-months, respectively. For positive blood culture the pooled mean rates were 0.2, 1.0, 1.9 and 2.7 per 100 patient-months in these groups. The IV antibiotics starts event pooled mean rates were 5.9, 9.0, 11.8, and 11.2 per 100 patient-months. DE were significantly more common in patients with permanent and temporary catheters when compared with patients with fistulas and graft (p<0.001). Surveillance of DE rates in Kuwait revealed significantly lower mean rate of hospitalization and positive blood culture while IV antimicrobial start shows significantly higher mean rate when compared to published NHSN data.

Medicare Reimbursement Attributable to Catheter-associated Urinary Tract Infection in the Inpatient Setting

Most catheter-associated urinary tract infections (CAUTIs) are considered preventable and thus a potential target for health care quality improvement and cost savings. We sought to estimate excess Medicare reimbursement, length of stay, and inpatient death associated with CAUTI among hospitalized beneficiaries. Using a retrospective cohort design with linked Medicare inpatient claims and National Healthcare Safety Network data from 2009, we compared Medicare reimbursement between Medicare beneficiaries with and without CAUTIs. Fee-for-service Medicare beneficiaries aged 65 years or older with continuous coverage of parts A (hospital insurance) and B (supplementary medical insurance). We found that beneficiaries with CAUTI had higher median Medicare reimbursement [intensive care unit (ICU): $8548, non-ICU: $1479) and length of stay (ICU: 8.1 d, non-ICU: 3.6 d) compared with those without CAUTI controlling for potential confounding factors. Odds of inpatient death were higher among beneficiaries with versus without CAUTI only among those with an ICU stay (ICU: odds ratio 1.37). Beneficiaries with CAUTI had increased Medicare reimbursement and length of stay compared with those without CAUTI after adjusting for potential confounders.

Impact of Medicare's Payment Policy on Mediastinitis Following Coronary Artery Bypass Graft Surgery in US Hospitals

The Centers for Medicare and Medicaid Services (CMS) implemented a policy in October 2008 to eliminate additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) surgery. To evaluate the impact of this policy on mediastinitis rates, using Medicare claims and National Healthcare Safety Network (NHSN) prospective surveillance data. We used an interrupted time series design to compare mediastinitis rates before and after the policy, adjusted for secular trends. Billing rates came from Medicare inpatient claims following 638,761 CABG procedures in 1,234 US hospitals (January 2006-September 2010). Prospective surveillance rates came from 151 NHSN hospitals in 29 states performing 94,739 CABG procedures (January 2007-September 2010). Logistic regression mixed-effects models estimated trends for mediastinitis rates. We found a sudden drop in coding for index admission mediastinitis at the time of policy implementation (odds ratio, 0.36 [95% confidence interval (CI), 0.23-0.57]) and a decreasing trend in coding for index admission mediastinitis in the postintervention period compared with the preintervention period (ratio of slopes, 0.83 [95% CI, 0.74-0.95]). However, we saw no impact of the policy on infection rates as measured using NHSN data. Our results were not affected by changes in patient risk over time, heterogeneity in hospital demographics, or timing of hospital participation in NHSN. The CMS policy of withholding additional Medicare payment for mediastinitis on the basis of claims-based evidence of infection was associated with changes in coding for infections but not with changes in actual infection rates during the first 2 years after policy implementation.

Central line associated blood stream infection rate after intervention and comparing outcome with national healthcare safety network and international nosocomial infection control consortium data.

Background:Benchmarking of central line associated blood stream infection (CLABSI) rates remains a problem in developing countries due to the variations in surveillance practices and/or infection risk as non-availability of national data.Aim:The aim of the following study was to find out the CLABSI rate before and after central line (CL) bundle intervention and compare the outcome with international surveillance data.Subjects and Methods:This prospective longitudinal cohort study on adult intensive care unit patients was conducted at Hera General Hospital, Makkah Saudi Arabia from January 1 to December 31, 2012. Five key components of bundle were selected; hand hygiene, maximal barrier precautions upon insertion, skin antisepsis, optimum site selection and daily review of line necessity with prompt removal of unnecessary lines. Post-intervention CLABSI rate was compared with National Healthcare Safety Network (NHSN) and International Nosocomial Infection Control Consortium (INICC) rates. Statistical Package for the Social Sciences (SPSS) 14.0 software (SPSS Inc., 233 South Wacker Drive, 11th floor Chicago, USA) was used for statistical analysis included regression analysis for correlation. Statistical significance was set at P < 0.05.Results:CLABSI rate was reduced from 10.1 to 6.5 per 1000 CL days after interventions and had significant correlation with overall bundle compliance rate 87.6% (P = 0.02) On benchmarking, CLABSI rate after the intervention was similar to mean pool value of INICC (6.8) while higher than NHSN (3.1). The most common microorganisms isolated were; methicillin-resistant Staphylococcus aureus (30.8%), Acinetobacter baumanii (23.3%) and Enterococcus faecalis (15.4%).Conclusion:We found that INICC data was a better benchmarking tool comparative to NHSN because it represents the countries that are developing the surveillance system. A multicenter national study is recommended.

Itemizing the bundle: Achieving and maintaining “zero” central line-associated bloodstream infection for over a year in a tertiary care hospital in Saudi Arabia

"Zero" central line-associated bloodstream infections (CLABSI) have not been reported from Asian countries, which usually have predominance of difficult to curtail gram negative infections. It also remains unclear whether lowering CLABSI rates below National Healthcare Safety Network (NHSN) benchmarks in such countries is even possible. In this study, we evaluated effects of a quality improvement initiative to achieve "Zero CLABSI" in our intensive care unit. A root cause analysis in February 2010 identified problems with clinical practice, environment, and products. Extensive education sessions were followed by implementation of strategies in the form of "itemized" bundles derived from practice guidelines, with complete enforcement starting August 2010. Results were benchmarked against NHSN data. Data were analyzed in a preintervention (1 year) and postintervention (2 years) fashion, using Poisson regression analysis to generate incidence-rate ratio (IRR). In the preintervention period, CLABSI rate was 6.9/1,000 catheter-days (CDs) (35 CLABSI/5,083 CDs). In the postintervention year 1, rate was 1.06/1,000 CDs (4 CLABSI/3,787 CDs) with IRR of 0.15 (95% confidence interval: 0.04-0.44, P < .001) and reduction of 85%. In postintervention year 2, rate was 0.35/1,000 CDs (1/2,860 CDs) with IRR of 0.05 (95% confidence interval: 0.001-0.31, P < .001). There was a period of "Zero CLABSI" for 15 consecutive months, surpassing NHSN benchmarks. CLABSIs can be eliminated in any intensive care unit regardless of the location and type of organism. NHSN data should be a realistic CLABSI benchmarking target for developing countries.