Executive Summary

Background

Healthcare-associated infections (HAIs) are infections that people acquire while they are receiving treatment for another condition in a health care setting. They are costly, deadly, and largely preventable. The U.S. Department of Health and Human Services' Action Plan to Prevent Healthcare-Associated Infections is focusing attention on the need to dramatically reduce these infections; a recent Centers for Disease Control and Prevention (CDC) report suggests that considerable progress is being made towards this goal. As part of this initiative, the Agency for Healthcare Research and Quality (AHRQ) is funding a national effort to prevent central line-associated bloodstream infections (CLABSIs) in U.S. hospitals. The On the CUSP: Stop BSI project is led by a unique partnership. This partnership consists of the Health Research & Educational Trust, the nonprofit research and educational affiliate of the American Hospital Association; the Johns Hopkins University Quality and Safety Research Group, which developed an innovative approach for improving patient safety; and the Michigan Health & Hospital Association's Keystone Center for Patient Safety & Quality, which used this approach to dramatically reduce CLABSIs in Michigan. This report summarizes progress made in the first 2 years of the On the CUSP: Stop BSI project.

Participation

On the CUSP: Stop BSI requires that participating States have a lead organization that works with hospitals across their State to implement the clinical and cultural changes needed to reduce CLABSIs.  Thus far, 46 hospital associations and one umbrella group have committed to leading the project in their States.  Collectively, these groups have recruited more than 1,055 hospitals and 1,775 hospital teams to participate in the project.  Twenty-two States began the project in 2009, 14 States and the District of Columbia began during 2010, and 9 States and Puerto Rico began the effort in 2011. 

Project Impact

• We examined the impact of the project on patients from units/teams in cohorts 1-4 that began participating in the project in 2009 and 2010. Compared to a baseline CLABSI rate of 1.87 infections per 1,000 central line days in these units, after 10-12 months of participation in the project, CLABSI rates in these cohorts have decreased to 1.25 infections per 1,000 central line days, a relative reduction of 33 percent. 
• The percentage of units with zero quarterly CLABSIs increased from 27.3 percent at baseline to 69.5 percent for cohorts 1 through 4 at the end of period 4.
• For improvement in safety culture, there was little change in team members' responses to questions about the safety culture on their units between the baseline and followup surveys.

Conclusions

Progress toward achieving the project's stated goals is encouraging, but substantial work remains.  Key conclusions thus far include:

• Hospital adult ICUs included in this report are drawn from 32 states and territories, and more than 750 hospitals. This is an increase of 10 states and 400 hospitals since November 2010.  These units have reduced their CLABSI rates by an average of 33 percent.  As of November 2010, CLABSI rates had decreased by an average of 35 percent indicating rates are continuing to decrease but at a marginally slower rate.
• At baseline, many of these units had CLABSI rates below the national mean and were still able to reduce their rates.
• The project demonstrates that even among hospitals that have already achieved low CLABSI rates, further improvement is possible and achievable.

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