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About the Initiative

Case studies from the On the CUSP: Stop BSI initiative are available. The action guide, Stories of Success: Using CUSP to Improve Safety, contains the stories of four hospitals that participated in the initiative and applied the Comprehensive Unit-based Safety Program, or CUSP, to dramatically reduce central line-associated bloodstream infections (CLABSI) and other health care-associated infections.

While health care-associated infections were once seen as an unavoidable risk of providing care, a successful nationwide program to reduce the deadliest of these infections has proven that change is possible.

Funded by the Agency for Healthcare Research and Quality (AHRQ), On the CUSP: Stop BSI was a national initiative to implement a proven culture change model, the Comprehensive Unit-based Safety Program (CUSP) and interventions to prevent central line-associated bloodstream infections (CLABSI). The project achieved landmark results that included:

  • Reducing overall rates of CLABSI by 40 percent
  • Preventing more than 2,000 CLABSIs
  • Saving more than 500 lives
  • Avoiding more than $34 million in health care costs

Read the AHRQ press release on the success of On the CUSP: Stop BSI.

The initiative had three key goals:

  • Reducing the mean CLABSI rate across the nation to less than 1 per 1,000 catheter days over two years
  • Improving safety culture
  • Partnering with the Centers for Disease Control and Prevention to support the measurement and timely feedback of CLABSI and other health care acquired infection (HAI) data, and for state hospital associations to partner with state-based organizations to address the elimination of HAIs

On the CUSP: Stop BSI was led by the Health Research & Educational Trust (HRET) of the American Hospital Association. HRET’s National Project Team consisted of the Michigan Health & Hospital Association’s Keystone Center for Patient Safety & Quality (MHA Keystone Center) and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality (formerly the Johns Hopkins University Quality and Safety Research Group). Forty-four states, the District of Columbia, and Puerto Rico all enrolled hospital units in the program. Collectively, more than 1,000 hospitals and 1,800 hospital unit teams participated in the initiative.

The basis of the initiative formed in 2003, when the MHA Keystone Center, together with patient safety innovators from Johns Hopkins, implemented a project in 127 intensive care units in the state of Michigan to apply the CUSP culture change model and evidence-based interventions to reduce CLABSI. The Michigan ICU project was an astounding success, achieving within 18 months a median CLABSI rate of zero and sustaining these reductions to the present time.

In 2008, AHRQ awarded a contract to HRET to replicate the 2003 Michigan ICU project to reduce CLABSI in ten states across the country. HRET and its partners at the MHA Keystone Center and Johns Hopkins formed On the CUSP: Stop BSI. Like the earlier Michigan project, this new initiative implemented the CUSP culture change model and the following evidence-based interventions to reduce CLABSI:

  • Remove unnecessary central lines
  • Wash hands prior to inserting central lines
  • Use maximal barrier precautions during line insertion
  • Clean skin with chlorhexidine
  • Avoid the femoral site when inserting lines

AHRQ expanded On the CUSP: Stop BSI nationwide in 2009 and in 2010 began providing limited financial support to states participating in the 18-to-24-month project. Leaders at state hospital associations, QIOs, and other organizations played a crucial role in the success of the initiative, providing logistic support and working in tandem with faculty from the National Project Team. Through the initiative, state leaders expanded their capacity to implement future quality and safety improvement programs.

Unit teams that participated in the project achieved significant reductions in CLABSI rates. Preliminary findings indicated that hospitals participating in On the CUSP: Stop BSI reduced the rate of CLABSI nationally from 1.903 infections per 1,000 central line days to 1.137 infections per 1,000 line days, an overall reduction of 40 percent. What’s more, the percentage of units with zero CLABSIs per quarter increased from 30 percent at baseline to 68 percent among the first five of six cohorts participating in the program. This demonstrates that even for hospitals that have already achieved relatively low infections rates, further improvement is achievable.

Current trends in the health care field will facilitate further gains in the fight to reduce CLABSI.  Recent expansions in public reporting, policies of non-payment for hospital-acquired conditions, and the U.S. Department of Health and Human Services’ Action Plan to Prevent Healthcare-Associated Infections are all focusing attention on the need to eliminate CLABSI. Through the Partnership for Patients, a public-private partnership led by HHS, CLABSI is one of ten hospital-acquired conditions to be reduced by 40 percent by 2014. The 26 Hospital Engagement Networks (HENs) established by the Partnership for Patients are leading learning collaboratives and providing technical assistance for hospitals and monitoring hospitals’ progress toward providing safer care for their patients.