Moderating Factors

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

Readiness Assessment


Section Summary

  • A total of 342 Readiness Assessments were completed in adult ICUs.
  • Units most frequently reported they had fully implemented inclusion of chlorhexidine in their central line kit (94.7 percent) followed by use of an independent line cart or kit stocked with essentials for placing a central line catheter (83.0 percent).
  • Least frequently reported was the routine bathing of patients in clinical areas with chlorhexidine (20.7 percent) followed by use of an antiseptic or antibiotic impregnated or coated central catheter (43.6 percent).
  • Units in teaching hospitals or hospitals with greater than the median number of beds were more likely to report to the CDC NHSN (p<0.001).

Units were requested to complete a Readiness Assessment at baseline (go to Appendix G for complete instrument). The Readiness Assessment was designed to assess adoption of best clinical practices (e.g., frequency of bathing patients in clinical areas with chlorhexidine) and prior exposure to CUSP materials or participation in other CLABSI reduction efforts.

Results of Readiness Assessments presented below were restricted to adult ICUs and, when possible, matched to their hospital's 2010 AHA Annual Survey. Utilizing the AHA survey, units were classified as residing in teaching or non-teaching hospitals, and the median bed size of the sample was used to classify units as residing in hospitals with total bed size above or below the sample median. Readiness Assessment results that could not be matched to an AHA survey were classified as non-teaching and below the median bed size. Finally, for presentation purposes, results of the assessment were restricted to items considered most clinically relevant or pertinent to CUSP implementation. A total of 342 Readiness Assessments were completed among adult ICUs. Forty-five percent of units resided in teaching hospitals, and the median bed size was 230 (mean=311, stdev=256). Seven units could not be matched to their AHA surveys.

Survey responses can be found in Table 19. Most frequently, units reported they had fully implemented inclusion of chlorhexidine in their central line kit (94.7 percent). Least frequent was the routine bathing of patients in clinical areas with chlorhexidine (20.7 percent). Variability in responses was found based on teaching status and bed size. Units residing in either teaching hospitals or hospitals with greater than 230 beds were more likely to report to the CDC NHSN (p<0.001). Units residing in teaching hospitals were more likely to have participated in an organized multi-site effort to reduce CLABSI. Finally, units residing in hospitals with greater than 230 beds were more likely to, 1) use an independent line cart or kit stocked with essentials for placing a central line catheter, 2) use a line insertion checklist to ensure compliance with evidence-based practices, 3) use chlorhexidine impregnated patch for central venous line care and, 4) bathe patients in clinical care areas with chlorhexidine.

Table 19. Readiness Assessment results for adult ICUs

Assessment Question*All
(n=342)
Teaching StatusBed Size
Non-
Teaching
(n=187)
Teaching
(n=155)
p value≤230 beds
(n=175)
>230 Beds
(n=167)
p value
1Participation in any organized multi-site effort to reduce bloodstream infections43.9%20.5%23.4%0.00920.8%23.1%0.210
2Partnership' with a Senior Executive for patient safety49.4%26.6%22.8%0.76024.9%24.6%0.749
3Systematic analysis and proactive learning from harmful events or events with potential harm as raised by front-line staff (other than M&Ms and official RCA)52.3%28.4%24.0%0.84926.0%26.3%0.574
4Use of an independent line cart or kit, stocked with essentials for placing a central-line catheter83.0%43.3%39.8%0.03539.8%43.3%0.007
5Inclusion of chlorhexidine in central line kit94.7%51.5%43.3%0.57347.4%47.4%0.066
6Use of a line-insertion checklist to ensure compliance with evidence-based practices80.1%41.2%38.9%0.01637.7%42.4%0.002
7Does your hospital participate in reporting to the CDC NHSN?54.1%24.9%29.2%<0.00122.8%31.3%<0.001
8Does your ICU/Clinical Care Area currently use a chlorhexidine impregnated patch for central venous line care?67.5%34.2%33.3%0.03130.1%37.4%<0.001
9Does your ICU/Clinical Care Area currently use antiseptic or antibiotic impregnated or coated central catheters?43.6%24.0%19.6%0.90822.8%20.8%0.701
10Do you bathe patients in this clinical care area with chlorhexidine?20.7%8.8%12.0%0.0187.0%13.7%0.001

* Items 1-7 are considered a positive response if reported as "fully implemented" and items 8-10 are considered a positive response if reported as "Routinely."
† Total hospital beds median for sample used for stratification (median =  230, mean = 311, stdev = 256).
‡ Statistical significance considered at p<0.01 level.

Page last reviewed January 2013
Internet Citation: Moderating Factors: 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/clabsicomp5c.html