Eliminating CLABSI: A National Patient Safety Imperative
Introduction and Objective
Healthcare-associated infections (HAIs) are largely preventable, and their occurrence can be dramatically reduced, to save lives and excess costs. The Department of Health and Human Services (HHS) launched an Action Plan to Prevent Healthcare-Associated Infections to improve patient safety and health care quality by providing a roadmap for preventing HAIs. HHS also launched the Partnership for Patients initiative aimed at keeping patients from getting injured or sicker in the health care system and helping patients heal without complication by improving transitions from acute-care hospitals to other care settings. A recent Centers for Disease Control and Prevention (CDC) report suggests that considerable progress is being made in preventing central line associated blood stream infections, but that further improvement is still needed.1 To further the effort to prevent HAIs, two large-scale initiatives have been funded and launched by the Agency for Healthcare Research and Quality (AHRQ). The goal of these initiatives is to prevent both central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). Both initiatives use a combination of evidence-based best practices to reduce the risk of infections and the Comprehensive Unit-Based Safety Program (CUSP) to improve the culture of patient safety. Researchers at the Johns Hopkins University Quality and Safety Research Group (QSRG) initially developed CUSP. CUSP was subsequently implemented in collaboration with the Michigan Health & Hospital Association's Keystone Center for Patient Safety & Quality (MHA Keystone Center) and hospitals across Michigan. This implementation resulted in a dramatic and sustained decrease in CLABSI rates in that State.2
AHRQ has awarded contracts totaling $18 million to the Health Research & Educational Trust (HRET), the nonprofit research and educational affiliate of the American Hospital Association (AHA), to lead the national initiative to reduce CLABSI rates. HRET is partnering with the QSRG at Johns Hopkins University and the MHA Keystone Center to lead this effort. A recent expansion of HRET's contract now provides limited resources to the State hospital associations and other organizations leading this effort at the State level. Prior to this, these organizations funded their support of this project with their own resources or funds from other sources. The national On the CUSP: Stop BSI project represents the first federally funded national effort with a clearly stated outcome goal: the reduction of CLABSI rates to less than 1 per 1,000 central line days across all U.S. hospitals participating in the project. If this goal is achieved, the project will substantially reduce deaths and unnecessary costs associated with CLABSIs.
Since the project's inception in October 2008, lead organizations (primarily State hospital associations) have been recruited in 44 States. As of November 2010, 38 of these States have commenced participation in the On the CUSP: Stop BSI initiative; 22 of those States have hospitals that have been participating in the project and submitting data for over one year. Given the significance of AHRQ's investment in this project and the role that it plays in achieving HHS's HAI reduction goals, there is value in assessing the project to this point, with three specific goals in mind. A first goal is to examine progress made in recruiting U.S. hospitals to participate in the project. A second goal is to evaluate the impact of the project on CLABSI rates in these participating hospitals. Finally, this report seeks to identify areas where improvement must continue to occur for the project to achieve its stated goals.
1. Vital Signs: Central Line-Associated Blood Stream Infections—United States, 2001, 2008, and 2009. Morbidity and Mortality Weekly Report. Atlanta, GA: Centers for Disease Control and Prevention; 2011 Mar 1;60. Available at: http://www.cdc.gov/mmwr/pdf/wk/mm60e0301.pdf.
2. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006 Dec 28;355(26):272532.