lunes, 8 de octubre de 2012

Research Activities, October 2012: Agency News and Notes: AHRQ safety project reduces bloodstream infections by 40 percent

Research Activities, October 2012: Agency News and Notes: AHRQ safety project reduces bloodstream infections by 40 percent

Agency News and Notes

AHRQ safety project reduces bloodstream infections by 40 percent

A unique nationwide patient safety project funded by the Agency for Healthcare Research and Quality (AHRQ) reduced the rate of central line-associated bloodstream infections (CLABSIs) in intensive care units by 40 percent, according to the Agency's preliminary findings of the largest national effort to combat CLABSIs to date. The project used the Comprehensive Unit-based Safety Program (CUSP) to achieve its landmark results—preventing more than 2,000 CLABSIs, saving more than 500 lives, and avoiding more than $34 million in health care costs.
The Agency and key project partners from the American Hospital Association (AHA) and Johns Hopkins Medicine discussed these dramatic findings at the AHRQ annual conference in September in Bethesda, Maryland, and introduced the CUSP toolkit that helped hospitals accomplish this marked reduction.
"CUSP shows us that with the right tools and resources, safety problems like these deadly infections can be prevented," said AHRQ Director Carolyn M. Clancy, M.D. "This project gives us a framework for taking research to scale in practical ways that help front-line clinicians provide the safest care possible for their patients."
CLABSIs are one type of healthcare-associated infection (HAI). HAIs are infections that affect patients while they are receiving treatment for another condition in a health care setting. HAIs are a common complication of hospital care, affecting one in 20 patients in hospitals at any point in time.
The national project involved hospital teams at more than 1,100 adult intensive care units in 44 states over a 4-year period. Preliminary findings indicate that hospitals participating in this project reduced the rate of CLABSIs 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.
The CUSP is a customizable program that helps hospital units address the foundation of how clinical teams care for patients. It combines clinical best practices with an understanding of the science of safety, improved safety culture, and an increased focus on teamwork. Based on the experiences gained in this successful project, the CUSP toolkit helps doctors, nurses, and other members of the clinical team understand how to identify safety problems. It also gives them the tools to tackle these problems that threaten the safety of their patients. It includes teaching tools and resources to support implementation at the unit level.
The first broad-scale application of CUSP was in Michigan, under the leadership of the Michigan Health & Hospital Association, where it was used to significantly reduce CLABSIs in that State. Following that success, CUSP was expanded to 10 States and then nationally through an AHRQ contract to the Health Research & Educational Trust, the research arm of the AHA. "This partnership between the Federal government and hospitals provides clear evidence that we can protect patients from these deadly infections," said AHA President and CEO Richard J. Umbdenstock. "Hospitals remain committed to curtailing CLABSIs and enhancing safety in all clinical settings. Tools such as CUSP go a long way toward accomplishing that goal."
CUSP was created by a team led by Peter J. Pronovost, M.D., Ph.D., senior vice president for patient safety and quality at Johns Hopkins Medicine. "It is gratifying that this method has become such a powerful engine for improving the quality and safety of care nationwide," said Dr. Pronovost. "It is a really simple concept; trust the wisdom of your front-line clinicians." In addition, CUSP also builds on important work led by the Centers for Disease Control and Prevention and its evidence-based recommendations on treating infections. Together with HHS' National Action Plan to Prevent Healthcare Associated Infections ( and the Partnership for Patients (, AHRQ's efforts are a part of a coordinated approach drawing on the strengths and expertise across HHS.
Details about AHRQ's national CUSP project are available at AHRQ's CUSP toolkit is available at

Healthcare-Associated Infection (HAI)

Healthcare-associated infections, or HAIs, are infections that people acquire while they are receiving treatment for another condition in a healthcare setting. HAIs can be acquired anywhere healthcare is delivered, including inpatient acute care hospitals, outpatient settings such as ambulatory surgical centers and end-stage renal disease facilities, and long-term care facilities such as nursing homes and rehabilitation centers. HAIs may be caused by any infectious agent, including bacteria, fungi, and viruses, as well as other less common types of pathogens.
These infections are associated with a variety of risk factors, including:
  • Use of indwelling medical devices such as bloodstream, endotracheal, and urinary catheters
  • Surgical procedures
  • Injections
  • Contamination of the healthcare environment
  • Transmission of communicable diseases between patients and healthcare workers
  • Overuse or improper use of antibiotics
Magnitude of the Problem
HAIs are a significant cause of morbidity and mortality. At any given time, about 1 in every 20 inpatients has an infection related to hospital care. These infections cost the U.S. healthcare system billions of dollars each year and lead to the loss of tens of thousands of lives. In addition, HAIs can have devastating emotional, financial and medical consequences.
A majority of hospital-acquired HAIs include:
  • Urinary tract infections
  • Surgical site infections
  • Bloodstream infections
  • Pneumonia
Call to Action
There is growing consensus that our ultimate goal should be the elimination of HAIs. To coordinate and maximize the efficiency of prevention efforts, a senior-level Federal Steering Committee for the Prevention of Healthcare-Associated Infections was established in 2008. Members include clinicians, scientists, and public health leaders who are high-ranking officials from the U.S. Department of Health and Human Services(HHS), U.S. Department of Defense, U.S. Department of Labor, and U.S. Department of Veterans Affairs. The Steering Committee marshaled the extensive and diverse resources across the federal government, formed public and private partnerships, and initiated discussions that identified new approaches to HAI prevention and collaborations.
In 2009, the HHS Assistant Secretary for Health created the Office of Healthcare Quality (OHQ) to support and carry out the Steering Committee’s mandate to improve healthcare quality by preventing and eventually eliminating HAIs. The Steering Committee developed the National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination. At a meeting held in late 2010, subject matter experts (SMEs) met to discuss strategies to accelerate the progress towards national infection reduction goals. Since the 2010 meeting, several other large national meetings, as well as specific stakeholder meetings have taken place to build upon the strategies discussed at the 2010 meeting.
As the HAI Action Plan is a living document, the Steering Committee released a new iteration of the HAI Action Plan (open for public comment from April-June 2012) that incorporates new research and information. The updated iteration will be released fall 2012.
In April 2011, HHS announced another way it is committed to patient safety:-Partnership for Patients (PfP). It is a new public-private partnership to make hospital care safer, more reliable, and less costly by:
  • Keeping hospital patients from getting injured or sicker. By the end of 2013, to decrease instances of patients acquiring preventable conditions while in hospitals by 40 percent compared to 2010.
  • Helping patients heal without complication. By the end of 2013, to decrease preventable complications during a transition from one care setting to another, so that the number of patients who must be re-admitted to the hospital would be reduced by 20 percent compared to 2010.

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