AHRQ's Healthcare-Associated Infections Program
Healthcare-associated infections (HAIs) are among the leading threats to patient safety, affecting one out of every 25 hospital patients at any one time. Over a million HAIs occur across the U.S. health care system every year, leading to the loss of tens of thousands of lives and adding billions of dollars to health care costs. Fortunately, most HAIs are preventable.
AHRQ's HAI Program supports projects to advance the science of HAI prevention, develop more effective approaches for reducing HAIs, and help clinicians apply proven methods to prevent HAIs on the front lines of care. The projects funded by AHRQ's HAI Program accelerate the implementation of evidence-based methods to reduce HAIs in acute care hospitals and in ambulatory and long-term care settings, in accordance with the framework established by the Department of Health and Human Services' National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination.
The AHRQ HAl Program supports a robust portfolio of grants and contracts directed toward research on reducing HAIs and wide-scale implementation of proven methods to prevent these dangerous infections. AHRQ's projects focus on the applied end of the research continuum. These research projects generate evidence for developing and demonstrating effective interventions to reduce HAIs. The results of this research advance the ability of clinicians in the field to combat HAIs.
The free tools and resources noted below are derived from these research and implementation projects. Physicians, nurses, infection control, quality improvement, and other health care professionals can employ these tools in their facilities to prevent HAIs and keep patients safer in acute care hospitals, nursing homes and other long-term care settings, doctors' offices, ambulatory surgery centers, and end-stage renal disease facilities.
Tools & Resources to Prevent HAIs
The Comprehensive Unit-based Safety Program (CUSP) is an example of how AHRQ uses its HAl research dollars to develop proven methods to prevent HAIs and implement those methods on a large scale. CUSP combines techniques to improve safety culture, teamwork, and communications, together with a checklist of proven practices. CUSP can be applied to any safety problem, but it was first shown to be effective in reducing central line-associated bloodstream infections (CLABSIs) in 100 Michigan intensive care units and was then spread across the country. In that project, hospital ICUs reduced CLABSIs by 41 percent, preventing more than 2,100 infections, saving over 500 lives, and averting more than $36 million in excess costs. The CUSP Toolkit was developed based on this experience, allowing other hospitals to apply this proven method. More information about CUSP can be found at http://go.usa.gov/8bhB.
- CUSP Toolkit
The CUSP Toolkit helps professionals and facilities apply CUSP to make health care safer. It includes checklists, PowerPoint slides, facilitator notes, instructional videos, education on the science of safety, and other resources. Created by clinicians for clinicians, the toolkit is modifiable to meet individual unit needs.
- CLABSI Tools
These tools were specifically developed to apply the CUSP framework to prevent CLABSIs.
- Toolkit for Reducing CAUTI in Hospitals
The toolkit consists of three modules—Implementation, Sustainability, and Resources—that a hospital unit can use to teach team members specific ways to create a culture of safety and adopt best practices regarding CAUTI prevention.
- AHRQ Safety Program for Surgery
This ongoing project will result in a toolkit for use in surgical units to improve safety culture and reduce surgical site infections and other complications.
- AHRQ Safety Program for Mechanically Ventilated Patients
This ongoing project aims to make care safer for patients in intensive care units who require the assistance of a ventilator to breathe.
- AHRQ Safety Program for Ambulatory Surgery
This ongoing project will result in resources to reduce surgical site infections and other surgical complications within ambulatory surgery centers.
- AHRQ Safety Program for Long-Term Care: Preventing CAUTI and Other HAIs
This ongoing project focuses on reducing catheter-associated urinary tract infection (CAUTI) and other HAIs in nursing homes and long-term-care facilities.
This online protocol provides instructions for implementing universal decolonization in adult ICUs, as was done in the REDUCE MRSA Trial (Randomized Evaluation of Decolonization vs. Universal Clearance to Eliminate Methicillin-Resistant Staphylococcus aureus). The trial found that universal decolonization reduced bloodstream infections and the presence of MRSA (New England Journal of Medicine, May 29, 2013).
Carbapenem-resistant Enterobacteriaceae (CRE) refers to a family of bacteria that are difficult to treat because they have high levels of resistance to antibiotics. KPC (Klebsiella pneumoniae carbapenemase) is a highly dangerous type of CRE that has emerged as a major threat to patient safety because it is resistant to known treatments and kills more than half of patients who become infected with it. AHRQ, working with leading KPC researchers, developed a toolkit that hospitals can use to help control and prevent KPC outbreaks in their facilities.
This online toolkit includes resources to help hospitals implement an antimicrobial stewardship program, or ASP, to specifically target C. difficile in their facility. The toolkit answers questions that hospitals commonly have when considering how to set up an ASP, such as “Is my organization ready?” and “How do I select the right intervention?” It is based on the Antimicrobial Stewardship Toolkit, which includes best practices from the Greater New York Hospital Association/United Hospital Fund Antimicrobial Stewardship Collaborative.
This ongoing project brings together subject matter experts and dialysis providers to develop a field-tested toolkit to help reduce HAIs in dialysis patients. The science-based and practical resources in the toolkit can be implemented by ESRD clinics. More information on the project, including early release tools, is available.
The Nursing Home Antimicrobial Stewardship Modules include four tested, evidence-based toolkits to help optimize antibiotic use in nursing homes. The modules are intended to assist nursing homes develop antimicrobial programs.
This checklist provides sequential critical steps that have shown to reduce central line-associated infections.
AHRQ has commissioned a 3-year HAI Synthesis Project, which is reviewing and aggregating the findings and results of HAI research and implementation projects funded by AHRQ, primarily in the core period from fiscal years 2007 to 2010. The overall project will present important results for dissemination to the field and will report HAI knowledge gaps identified by project teams. The Synthesis Project includes four distinct pieces that together provide a unique perspective on the results of AHRQ-funded HAI projects.
More than 1,000 hospital units participating in this national implementation project used CUSP to reduce CLABSIs by 41 percent. Read the Companion Guide to the Final Report.
One hundred neonatal intensive care units used CUSP to reduce CLABSIs by 58 percent.
A July 2013 interim report from this ongoing project indicates that hospitals using CUSP were able to reduce CAUTI rates by 16 percent at 14 months post-baseline.
This analysis of case studies developed from participants in AHRQ's CUSP national implementation project describes specific practices and "success factors" for reducing and eliminating CLABSIs in health care facilities.
A peer-reviewed article appearing in the June 2013 issue of New England Journal of Medicine reports the results of the REDUCE MRSA trial, a three-arm, cluster-randomized trial, to compare strategies for preventing ICU infections. The study was funded by AHRQ and conducted in collaboration with the Centers for Disease Control and Prevention. The trial found that universal decolonization was more effective than screening and isolation or screening and selective decolonization in reducing bloodstream infections and the presence of MRSA.
A peer-reviewed article appearing in the October 2013 issue of the Journal of the American Medical Association reports the result of an AHRQ-funded cluster-randomized trial in 20 medical and surgical ICUs in 20 hospitals. Researchers found that universal glove and gown use reduced the acquisition of MRSA but not vancomycin-resistant Enterococcus.
This summary for clinicians of a systematic review examined the comparative effectiveness of diagnostic tests, treatments, and prevention strategies for C. difficile infections in adults.