CKM and Central Line Infections

A recent article from the CDC reports that "Compared to 2001, approximately 58% fewer bloodstream infections occurred in 2009 in ICU patients with central lines." (see full Vital Signs article)


This improvement has largely been based on the acceptance and implementation of the "Central Line Bundle." According to the IHI, the bundle consists of:

• Hand Hygiene
• Maximal Barrier Precautions During Insertion
• Chlorhexidine Skin Antisepsis
• Optimal Catheter Site Selection
• Daily Review of Line Necessity

This bundle may seem unrelated to clinical knowledge management, but it is an excellent example of the potential effects of clinical knowledge management, even when the process is unintentionally used.

This bundle was originally created during a research study at the Johns Hopkins University in 1998, published in 2004, performed by Peter Pronovost and others. The bundle compiled evidence-based practices for preventing central line infections into a single, digestible checklist. While the researched might not have set out to use the clinical knowledge management process, their success is a direct reflection on how well the CKM process was executed. Let me walk you through each step of the process, and how it was completed in this study.


Capturing and Classifying: The capturing and classifying of medical data, information, and even knowledge occurs on almost a daily basis through the publication of peer-reviewed medical journals and websites. The evidence on best practices to reduce central line infections was available to the researchers at the time of their literature review.


Retrieving: The identification and collection of articles that contained data, information, and knowledge about best practices to prevent central line infections represents the retrieval component of the CKM process.


Evaluating: The thoughtful analysis of which components in the literature review represented the greatest successes and were necessceary to include in their intervention embodies the evaluation step of the CKM process.

Sharing: The creation of the new knowledge represented by the checklist was not enough to initiate change; the researchers had to share their results in a meaningful way. They did this through a well-designed education and implementation plan.

Action: The change in practice by clinicians that occurred after the implementation of the checklist is the action component of the CKM process.

Just like the CKM process requires you to constantly be re-evaluating the effectiveness of your action, the researchers reevaluated their intervention. When the intervention was shown to be effective, the researchers shared this new knowledge with the medical community at large through the publication of their results. As others around the country implemented this checklist as the result of Johns Hopkins success, the results were analyzed and published. The communication of these results spurred even more hospitals and clinicians to implement the checklist and eventually led to endorsement by the CDC.

This continued utilization of the CKM process, although unknown to those using it, has greatly contributed to the 58% reduction in central line infections reported by the CDC. Imagine how much greater that reduction would be if the process had been used intentionally.