Outcomes

A Companion Guide to the National On the CUSP: Stop BSI Project Final Report

Adult ICUs


Section Summary

  • Data from over 1,100 adult ICUs were examined.
  • CLABSI rates were reduced from 1.915 at baseline to 1.133 at quarter six, a relative reduction of over 40 percent.
  • Variability in relative reduction was found by cohort and hospital characteristics.

A total of 1,185 adult ICUs reported at least one data point. Units that formally withdrew were excluded (n=50)3, and units that never reported post-baseline data were excluded (n=11), resulting in a final analytic sample of 1,124 units. One unit did not report data between quarter one and quarter six but did report during quarters seven and eight. On average, units had less than one missing post-baseline quarter worth of data (mean=0.36; stdev=0.96; median=0).

Overall

Overall CLABSI rates over time can be found in Figure 8. Table 2 illustrates the number of units reporting for each time period. Figure 9 illustrates the percentage of units reporting a rate of zero (shown in dark blue) or less than one (shown in light blue) during each time period. At baseline 30 percent of units reported a rate of zero. At quarter six, this percentage more than doubled with 68 percent of units reporting a rate of zero. Summary results for all adult ICUs can be found in Table 3.

Figure 8. Adult ICU CLABSI rate overall over time

Table 2. Number of ICUs reporting data at each time point

BaselineQ1Q2Q3Q4Q5Q6
9771,0781,0831,0881,0581,0261,004

 

Figure 9. Percent of reporting ICU units with CLABSI rate of zero or less than one, all cohorts

* Percentage of units calculated as number of units with a rate of zero or less than one divided by the total number of units reporting during the time period.

Table 3. Summary for adult ICU cohorts 1-6 through quarter 6

 Pre-InterventionPost-Intervention
BaselineQ1Q2Q3Q4Q5Q6
12 MonthsMonths
1-3
Months
4-6
Months
7-9
Months
10-12
Months
13-15
Months
16-18
Number of States Reporting46454646464544
Number of Units Reporting9771,0781,0831,0881,0581,0261,004
Average CLABSIs/Unit3.3180.8700.7290.6690.5710.5620.518
Average CL Days/Unit1,733487483488467459457
Rate:
(Infections/Days)x1,000
1.9151.7851.5111.3721.2211.2251.133
Relative Reductionn/a-7%-21%-28%-36%-36%-41%

By Cohort

Figure 10. CLABSI rate by cohort over time for adult ICUs

Table 4. Number of ICUs reporting data at each time point by cohort*

CohortBaselineQ1Q2Q3Q4Q5Q6
Cohort  1275280281290285291288
Cohort  2244290290292282267282
Cohort  380808078787773
Cohort  4152183187186185183178
Cohort  5129145146145141131126
Cohort  6971009997877757

* Note: As of the October 15, 2012, extract, the sixth project quarter for cohort 6 had not concluded.

By Hospital Characteristics

Figure 11. Adult ICU CLABSI rate overall over time by hospital characteristic

* Critical access hospitals (n=23) experienced one infection in 284 central line days (the lowest number of central line days reported during any quarter for critical access hospitals) resulting in a rate of 3.52 for quarter six.

Table 5. Number of ICUs reporting data at each time point by hospital characteristics

Hospital CharacteristicsBaselineQ1Q2Q3Q4Q5Q6
In A System584622624624609594575
In Largest 100 US Cities220229230228226228212
Critical Access Hospital19212122222219
Rural Hospital155180183183178172165
Teaching Hospital447462463464451441424

By Bed Size

Figure 12. Adult ICU CLABSI rate overall over time by hospital bed size

Table 6. Number of ICUs reporting data at each time point by hospital bed size

Hospital Bed SizeBaselineQ1Q2Q3Q4Q5Q6Q7Q8
0-100116138140141141139133121106
101-17513514815114814413713411396
176-2501321371371331271221119380
251-3251131191191191131091049889
326-400991021021069996948668
>400278286286288285283270250233

3. This number does not reflect units that formally withdrew but had not submitted any data. For details regarding project withdrawal see Participation section.

Page last reviewed January 2013
Internet Citation: Outcomes: A Companion Guide to the National On the CUSP: Stop BSI Project Final Report. January 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/cusp/clabsi-final-companion/clabsicomp4.html