CUSP Helps University of Wisconsin Hospital and Clinics Reduce Healthcare-Associated Infections

One year after implementing AHRQ's Comprehensive Unit-based Safety Program (CUSP), the University of Wisconsin Hospital and Clinics (UWHC) was awarded the 2013 Partnership in Prevention award for its achievement in significantly reducing healthcare-associated infections (HAIs). UWHC is a 566-bed academic medical center with 85 outpatient clinics based in Madison, Wisconsin.

HAIs are one of the most common complications of hospital care. Nearly two million patients develop them annually, which contribute to 99,000 deaths and $28 billion to $33 billion in health care costs.

The Partnership in Prevention award was given by the U.S. Department of Health and Human Services, the Association for Professionals in Infection Control, and the Society for Healthcare Epidemiology of America. It recognized UWHC's work in preventing two common HAIs—catheter-associated urinary tract infections (CAUTIs) and ventilator-associated pneumonia (VAP)—in the neuroscience intensive care unit.

"CUSP helped us to have a systematic approach for all our efforts," says Nasia Safdar, M.D., UWHC's infection control chief and associate professor of medicine at the University of Wisconsin School of Medicine and Public Health. Before implementing CUSP, UWHC's infection prevention interventions were "more sporadic and not as well integrated into the workflow," she notes, adding, "We got much more favorable outcomes as a result [of CUSP]."

At the end of 2012, CAUTI rates were 3.5 per 1,000 catheter days, a reduction of more than 25 percent compared with the previous year. Meanwhile, UWHC had only two VAP infections on its 24-bed neuroscience unit between November 2011 and June 2013. This represented a decrease by nearly 87 percent from previous years. 

AHRQ's CUSP is a structured strategic framework for safety improvement that integrates communication, teamwork, and leadership to create and support a culture of patient safety that can prevent harms. The program features evidence-based safety practices, staff training tools, standards for consistently measuring infection rates, methods to engage leadership, and tools to improve teamwork among doctors, nurses, and other members of the health care team.

After implementing CUSP, the hospital's infection prevention efforts became "much more standardized and organized," Dr. Safdar explains.

Dr. Safdar noted that elements of CUSP—such as its team-based approach, culture of safety, and checklists—really helped improve the mix of interventions UWHC had been using. These include hand washing, daily rounds on patients with indwelling catheters, catheter-removal protocols tied into the electronic health record, and recognizing CAUTI "champions" on each unit. Similar efforts were conducted on the VAP unit.

Initially, UWHC introduced CUSP to the trauma unit and the medical/surgical and neuroscience intensive care units. It has since been introduced throughout the hospital, and "we have applied it to other infections," says Dr. Safdar. "Our rates continue to fall," she notes, although she says it's harder to distill the numbers because of the change in the definition of CAUTI. In January 2013, the Centers for Disease Control and Prevention narrowed its definition of CAUTI to exclude asymptomatic bacteriuria—bacteria in urine without accompanying symptoms of a urinary tract infection, such as frequent urination, painful urination, or fever.

Dr. Safdar believes that too often, health care clinicians and professionals don't think CUSP relates to their work. That's unfortunate, she says, because it is very applicable. While it may take some time to implement, "once CUSP becomes entrenched, it's entrenched," she says.

Supported by AHRQ, CUSP was originally developed by the Johns Hopkins University and the Michigan Health & Hospital Association to implement a comprehensive unit-based safety program.

To learn more about CUSP, visit: http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/.