Using a Comprehensive Unit-based Safety Program to Prevent Healthcare-Associated Infections

Using a Comprehensive Unit-based Safety Program to Prevent Healthcare-Associated Infections


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The Agency for Healthcare Research and Quality (AHRQ) supports numerous projects that are helping hospitals in all 50 States, the District of Columbia, and Puerto Rico to employ a Comprehensive Unit-based Safety Program (CUSP) to reduce healthcare-associated infections (HAIs). The CUSP approach can be applied to patient safety problems, including various types of preventable infections, such as central line-associated blood stream infections (CLABSIs), catheter-associated urinary tract infections, and ventilator-associated pneumonia, in intensive care units (ICUs) and other hospital units.

This page provides an overview of CUSP and links to useful resources on the Web:
Using a Comprehensive Unit-based Safety Program to Prevent Healthcare-Associated Infections


Overview

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, engagement of leadership, and tools to improve teamwork among doctors, nurses, and other members of the health care team.

The following five steps from CUSP equip frontline providers with the tools, metrics, and framework to tackle the challenges of quality improvement:

•Step 1. Staff are educated on the science of safety.
•Step 2. Staff complete an assessment of patient safety culture.
•Step 3. A senior hospital executive partners with the unit to improve communications and educate leadership.
•Step 4. Staff learn from unit defects.
•Step 5. Staff use tools, including checklists, to improve teamwork, communication, and other systems of work.


CUSP in Action

CUSP was first applied on a large scale in the Keystone Project, which deployed this approach in more than 100 ICUs in Michigan beginning in 2003.The project targeted clinicians' use of five evidence-based procedures, recommended by the Centers for Disease Control and Prevention, to reduce rates of CLABSI: Hand hygiene, using full-barrier precautions during the insertion of central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site when possible, and removing unnecessary catheters. Using a checklist to ensure the procedures were followed, the Keystone Project:

•Reduced the rate of CLABSI by two-thirds within 3 months.
•Saved more than 1,500 lives and nearly $200 million in the program's first 18 months.
•Decreased the rate of CLABSI to the point where these infections became rare events in the participating ICUs, which continued to sustain this reduction 3 years after first adopting CUSP.

The findings of dramatically decreased infection rates were published in the December 28, 2006, issue of the New England Journal of Medicine (Select for abstract on PubMed® >> An intervention to decrease catheter-related blood... [N Engl J Med. 2006] - PubMed result).


CUSP Expansion

In October 2009, AHRQ announced an expansion of CUSP to hospitals in all 50 States, the District of Columbia, and Puerto Rico to continue the national implementation of this approach for reducing HAIs. The CUSP program also is expanding to include other settings in addition to ICUs, and more types of preventable infections. Select for press release: HHS Awards $17 Million in a New National Initiative to Fight Health Care-Associated Infections.



Keystone Project Shows Reduced Death Rates in ICUs

The Keystone Project also reported that Medicare patients treated in Michigan ICUs were less likely to die while hospitalized than Medicare ICU patients in other Midwestern hospitals that did not implement CUSP. Specifically, a person's chance of dying decreased by about 24 percent in Michigan after the program was implemented compared to only 16 percent in surrounding Midwestern states where the program was not implemented. Select for press release and abstract on PubMed®.

>> Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths Among Medicare Patients in Michigan Intensive Care Units
Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths Among Medicare Patients in Michigan Intensive Care Units


Impact of a statewide intensive care unit quality ... [BMJ. 2011] - PubMed result
full-text:
Impact of a statewide intensive care unit quality ... [BMJ. 2011] - PubMed result



Keystone Project Shows Reduced Pneumonia Rates in ICUs

Rates of pneumonia were also dramatically reduced in patients on ventilators in Michigan ICUs through the use of CUSP. Participating ICUs cut by more than 70 percent the rate of pneumonia in patients who were on ventilators. This reduction was sustained for the duration of the study's follow-up, a period of up to two and a half years. Select for press release.

>> Rates of Pneumonia Dramatically Reduced in Patients on Ventilators in Michigan Intensive Care Units
Rates of Pneumonia Dramatically Reduced in Patients on Ventilators in Michigan Intensive Care Units



CUSP Resources
Using a Comprehensive Unit-based Safety Program to Prevent Healthcare-Associated Infections