Healthcare-associated infections (HAIs) are a significant cause of illness, death, and excess cost in all health care settings. At any given time, HAIs affect 1 out of every 20 hospital patients. The U.S. Department of Health and Human Services' National Action Plan to Prevent Health Care-Associated Infections: Roadmap to Elimination focuses on the need to dramatically reduce these infections. As part of the National Action Plan, the Agency for Healthcare Research and Quality (AHRQ) is funding a nationwide effort to promote the use of the Comprehensive Unit-based Safety Program (CUSP) to prevent catheter-associated urinary tract infection (CAUTI) in U.S. hospitals. This project combines the implementation of general socio-adaptive approaches to improve care in a particular unit or hospital coupled with evidence-based interventions focusing on the technical aspects of CAUTI prevention.
The On the CUSP: Stop CAUTI project is a unit-based initiative with a primary goal of reducing the CAUTI rate in hospital units participating in the project by the completion of the 4-year initiative. Secondarily, this project seeks to make decreased CAUTI rates sustainable through fostering a culture of safety in participating units. The collaboration is led by the Health Research & Educational Trust (HRET) and its partners, the Michigan Health & Hospital Association's Keystone Center for Patient Safety & Quality(MHA Keystone), St. John Hospital and Medical Center, the University of Michigan Health System, and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, collectively referred to as the national project team.
To build on the strength of this collaboration and expand national support capacity, an Extended Faculty (EF) network has been developed. This EF group is a network of content experts from professional societies well known throughout health care: the Association for Professionals in Infection Control and Epidemiology (APIC), the Emergency Nurses Association (ENA), the Society for Healthcare Epidemiology of America (SHEA), and the Society of Hospital Medicine (SHM). This pool of faculty members serves as an additional resource for content development, leadership, and coaching for all stakeholders participating in the On the CUSP: STOP CAUTI national collaborative.
HAIs are among the most common preventable causes of mortality in the United States and a significant economic burden to the health care system. Approximately a quarter of all hospitalized patients have a urinary catheter placed during their hospital stay, and CAUTIs are among the most common HAIs in the United States. Yet, the majority of CAUTI cases are preventable. The national project team (NPT) believes that a national expansion of the original 10-State On the CUSP: Stop CAUTI initiative can play a critical role in reducing the frequency of catheter use and CAUTI. The NPT is charged with helping participating hospital units reduce their CAUTI rate and improve safety culture over the course of their 18- to 20-month participation in the On the CUSP: Stop CAUTI intervention.
The overall goal of this national expansion is to achieve a sustainable decrease in CAUTI and catheter use through the implementation of an evidence-based culture improvement strategy, CUSP, and application of the Centers for Disease Control and Prevention (CDC) Healthcare Infection Control Practices and Advisory Committee 2009 Guideline for the Prevention of Catheter-Associated Urinary Tract Infections. The Guideline's recommendations for the appropriate use of indwelling urinary catheters are similar to the "bladder bundle" developed by researchers working with the Keystone: HAI initiative of the MHA Keystone Center.1,2 The NPT has one primary goal and several secondary objectives for this project.
The primary goal is to reduce the CAUTI rate in participating units upon completion of the 4-year initiative. This project also seeks to make decreased CAUTI rates sustainable through fostering a culture of safety in participating units. The project will accomplish this by developing a national infrastructure that equips leaders across the country to continue reducing CAUTI after this national effort ends, and by applying the intervention to other key quality and safety issues within health care settings.
The secondary objective of this project is to maximize the impact of Federal resources invested in HAI reduction by ensuring effective coordination among these projects, the CDC's efforts to reduce HAIs through State health department-led efforts, Centers for Medicare & Medicaid Services' (CMS) investment in HAI reduction in the tenth scope of work for the Quality Improvement Organizations (QIOs), and CMS's Center for Medicare & Medicaid Innovation effort to reduce harm through Hospital Engagement Networks (HENs). The national project team builds on the original 10-State CAUTI reduction effort and leverages the connections, infrastructure, and expertise acquired in the highly successful national On the CUSP: Stop CLABSI effort in order to achieve these goals.
1 Saint S, Olmsted RN, Fakih MG, et al. Translating health care–associated urinary tract infection prevention research into practice via the bladder bundle. Jt Comm J Qual Patient Saf 2009 Sep;35(9):449-55. PMID: 19769204.
2 Fakih MG, Watson SR, Greene MT, et al. Reducing inappropriate urinary catheter use: a statewide effort. Arch Intern Med 2012 Feb 13;172(3):255-60. PMID: 22231611.