Hospitals Cut Central-Line Infections 40% With Safety Plan

September 10, 2012

September 10, 2012 — More than 1000 hospitals in 44 states lowered their rate of central line-associated bloodstream infections (CLABSIs) by 40% over 4 years through a program that features a checklist of precautions such as hand washing and donning sterile apparel, the federal Agency for Healthcare Research and Quality (AHRQ) announced today.

AHRQ estimates that the program prevented more than 2000 CLABSIs, saved more than 500 lives, and avoided more than $34 million in healthcare costs.

The AHRQ-funded program, called Comprehensive Unit-based Safety Program (CUSP), was developed by Peter Pronovost, MD, PhD, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore, Maryland.

Participating hospitals in a national rollout of CUSP reduced the CLABSI rate in their adult intensive care units on average from 1.903 infections per 1000 central-line days to 1.137 infections, according to AHRQ preliminary findings. At some hospitals already excelling at infection control, the CLABSI rate fell to zero. AHRQ funded the use of CUSP nationally through the research arm of the American Hospital Association.

The Centers for Disease Control and Prevention (CDC) puts the number of CLABSI cases at 250,000 annually in the United States, and the number of deaths at 30,000 to 62,000.

In 2009, the US Department of Health and Human Services set a number of 5-year goals for reducing healthcare-associated infections (HAIs). The target decrease for CLABSIs was a 50%.

AHRQ Director Carolyn Clancy, MD, said at a press briefing today that, until recently, physicians took HAIs for granted, viewing them as "an unfortunate consequence of care."

"They are not," said Dr. Clancy. "These infections are preventable."

It is possible to not only lower an ICU's CLABSI rate to zero, but also to keep it there for years at a time, noted Theresa Hickman, RN, a nurse educator at Peterson Regional Medical Center in Kerrville, Texas, at the press briefing. Consistency boils down to a matter of pride.

"Once [clinicians] get those zeros, they become extremely protective of those zeros," said Hickman, describing her own institution, which has been CLABSI-free for 2 years. The new attitude is "not in our hospital."

Free CUSP Toolkit Can Be Tailored to Any Unit, Any Safety Problem

To help more hospitals get on the anti-CLABSI bandwagon, AHRQ has posted a CUSP toolkit — free for the taking — on its Web site. The toolkit, created by clinicians for use in individual hospital units, includes videos, presentation slides, and facilitator notes as well as the CDC checklist for preventing CLABSIs. Toolkit modules instruct clinicians on understanding the science of safety, identifying safety issues in their units, creating teams, and improving communication. The CUSP toolkit can be customized for other settings besides the ICU and implemented at any pace.

CUSP works with any patient-safety issue, not just CLABSIs, according to AHRQ. Hospitals that have lowered their CLABSI rate with the program are applying it to other kinds of infections, such as urinary tract infections and ventilator-acquired pneumonia.

More information on CUSP is available on the AHRQ Web site.