Eliminating CLABSI: A National Patient Safety Imperative
Healthcare-associated infections (HAIs) are infections that people acquire while they are receiving treatment for another condition in a health care setting. They are costly, deadly, and largely preventable. The U.S. Department of Health and Human Services Action Plan to Prevent Healthcare-Associated Infections is focusing attention on the need to dramatically reduce these infections; a recent CDC Report suggests that considerable progress is being made towards this goal. As part of this initiative, the Agency for Healthcare Research and Quality (AHRQ) is funding a national effort to prevent central line-associated bloodstream infections (CLABSIs) in U.S. hospitals. The On the CUSP: Stop BSI project is led by a unique partnership. This partnership consists of the Health Research & Educational Trust, the nonprofit research and educational affiliate of the American Hospital Association; the Johns Hopkins University Quality and Safety Research Group, which developed an innovative approach for improving patient safety; and the Michigan Health & Hospital Association's Keystone Center for Patient Safety & Quality, which used this approach to dramatically reduce CLABSIs in Michigan. This report summarizes progress made in the first 2 years of the On the CUSP: Stop BSI project.
On the CUSP: Stop BSI requires that participating States have a lead organization that works with hospitals across their State to implement the clinical and cultural changes needed to reduce CLABSIs. Thus far, 45 State hospital associations and one other umbrella group have committed to leading the project in their States.Collectively, these groups have recruited more than 700 hospitals and 1,100 hospital teams to participate in the project. Twenty-two States began the project in 2009, 14 States and the District of Columbia began during 2010, and at least 8 States plus Puerto Rico will begin the effort in early 2011.
We examined the impact of the project on patients from the adult ICUs that began participating in the project during 2009. We focused on ICUs because data from these areas are the most valid. Compared to a baseline CLABSI rate of 1.8 infections per 1,000 central line days in these units, after 12-15 months of participation in the project, CLABSI rates have decreased to 1.17 infections per 1,000 central line days, a relative reduction of 35 percent. Progress for more recent participants is also being carefully evaluated.
Preliminary progress toward achieving the project's stated goals is encouraging, but substantial work remains. Key conclusions thus far include:
- Adult ICUs included in this report, drawn from 22 States and more than 350 hospitals, have reduced their CLABSI rates by an average of 35 percent.
- At baseline, many of these ICUs had CLABSI rates below the national mean and were still able to reduce their rates.
- While 20 percent of hospitals in the United States are participating in the project, many more hospitals and hospital units that insert or maintain central lines would benefit from involvement in the project.
- The project demonstrates that even among hospitals that have already achieved low CLABSI rates, further improvement is possible and achievable.