From the Director
As the patient safety field has matured in the past decade, we continue to witness evidence for the effectiveness of checklists, teamwork strategies, and other approaches to improve patient safety. One area that is advancing quickly is prevention of healthcare-associated infections (HAIs) like central line-associated bloodstream infections (CLABSIs). As part of the U.S. Department of Health and Human Services’ National Action Plan to Prevent Healthcare-Associated Infections, the Agency for Healthcare Research and Quality (AHRQ) funded a 4-year nationwide effort to prevent central line-associated bloodstream infections (CLABSIs) in U.S. hospitals beginning in 2008.
The over 1,000 adult intensive care units (ICUs) that participated in this project achieved a remarkable 41 percent reduction in the rate of CLABSIs over 18 months. A part of the nationwide project involved efforts to prevent CLABSI in ICUs for newborns. The dramatic 58 percent reduction in CLABSIs in 100 neonatal ICUs in nine States found in the project described in this month’s cover demonstrates the power of clinical teams that take appropriate steps to implement safe practices like those outlined in the Comprehensive Unit-based Safety Program (CUSP). CUSP developed out of observations that clinicians did not always follow, or missed, basic infection-prevention steps amid the highly complex and sometimes chaotic routines of critical care. That led to the introduction of a checklist of five specific interventions to prevent CLABSI in the hospital’s ICU. The CUSP checklist targets clinicians’ use of five evidence-based practices recommended by the CDC to prevent CLABSI: hand washing and hygiene; using full-barrier precautions during the insertion of central venous catheters; cleaning the skin with chlorhexidine; avoiding the femoral site when possible; and removing unnecessary catheters.
CUSP combines the use of such a checklist with improvements in safety culture, teamwork, and communications. It is this combination that makes CUSP such a powerful tool for reducing CLABSIs and other HAIs that can cause serious illness among adults and infants.
Carolyn Clancy, M.D.