Methods

Data Source

This report uses data stored in the On the CUSP: Stop BSI National Database created and maintained by the Michigan Health & Hospital Association's Keystone Center for Patient Safety & Quality (MHA Keystone Center) in Lansing, Michigan.  Each month, the number of central line days and the number of central line-associated bloodstream infections (CLABSIs) observed in the participating hospital units are submitted into the National Database.  Some hospitals submit infection rate data directly into this database, and others contribute data through the Centers for Disease Control and Prevention's (CDC's) National Healthcare Safety Network (NHSN).   All participants use CDC definitions to count central line days and determine the number of CLABSIs observed in participating units. 

All analyses are based on data drawn from the National Database on June 15, 2011.  Because we want to recognize as many of the hospitals that have chosen to participate as possible, a complete list of hospitals that have contributed to the national project database can be found at the project Web site at http://www.onthecuspstophai.org. 

Participation Measures

Data from the On the CUSP: Stop BSI National Database were linked to information in the 2009 AHA Annual Survey of hospitals based on hospital name, location, and AHA hospital identifier (when available and accurate).  All hospitals that could be linked were classified by size using the "total beds staffed" variable from the American Hospital Association (AHA) Annual Survey.  Hospitals were also classified based on whether they were critical access hospitals, rural referral hospitals, members of a health care system, located in one of the 100 largest cities in the United States, or are considered a teaching hospital by AHA.  Hospital characteristics were not available for those hospitals or for any hospitals that could not be matched to data in the AHA Annual Survey. Also excluded from the analyses were units without any baseline data (265 units) or without any followup data (15 units).

CLABSI Rates

CLABSI rates for the four cohorts were calculated for a baseline time period of up to 12 months before the CUSP intervention and for each subsequent 3-month time period (i.e., quarter).  The time periods are shown below.

Cohort	Intervention Date	2008								2009												2010												2011
		5	6	7	8	9	10	11	12	1	2	3	4	5	6	7	8	9	10	11	12	1	2	3	4	5	6	7	8	9	10	11	12	1	2	3	4	5
Cohort 1	5/1/2009	Baseline												Q1			Q2			Q3			Q4			Q5			Q6			Q7			Q8
Cohort 2	9/1/2009					Baseline												Q1			Q2			Q3			Q4			Q5			Q6			Q7
Cohort 3	2/1/2010										Baseline												Q1			Q2			Q3			Q4			Q5			Q6
Cohort 4	7/1/2010															Baseline												Q1			Q2			Q3			Q4

Central line days were calculated as the sum of all reported central line days during the reporting period, while the number of CLABSIs equaled the sum total of all CLABSIs reported during the period.  The unit level CLABSI rate equals the ratio of CLABSIs to central line days multiplied by 1,000. 

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