Johns Hopkins safety team works to eliminate bloodstream infections in the nation and the world

Feb 25 2009

A widely heralded Johns Hopkins safety initiative to reduce bloodstream infections in intensive care units (ICUs) was implemented in 30 states starting Feb. 1 and could save an estimated $3 billion dollars and 30,000 lives annually.

In addition, the program has been launched in Spain and will begin in the United Kingdom starting in April. Pilot programs are also under discussion with health care leaders in Peru and Chile.

"We ran this program in 77 hospitals and 103 intensive care units in Michigan for 18 months, and infections rates dropped 66 percent," says Peter Pronovost, M.D., Ph.D., director of the Johns Hopkins Quality and Safety Research Group (QRSG). "As a result, $200 million and an estimated 2,000 lives were saved. I'm confident we'll see a similar result nationwide."

The national program, National Implementation of the Comprehensive Unit-Based Safety Program (CUSP) to reduce Central-Line Associated Blood Stream Infections (CLABSI) in the ICU ("On the Cusp, Stop BSIs," for short), will continue through September 29, 2011. It's based on a checklist Pronovost created that significantly lowered CLASBI infections at Johns Hopkins and later throughout members of the Michigan Health & Hospital Association.

The international push is a cooperative effort between QSRG and the World Health Organization, except in the United Kingdom, where QSRG is working directly with representatives of that country.

The checklist contains five important steps that need to be followed when placing a central line catheter. This type of catheter is used regularly for patients in the ICU to administer medication or fluids, obtain blood tests, and directly gauge cardiovascular measurements such as central venous blood pressure. Each year, roughly 80,000 patients become infected and 30,000 to 60,000 die at a cost of $3 billion nationally.

Pronovost says his next step will be apply his checklists to other health care problems that are costing money and lives, such as methicillin resistant staphylococcus aureus (MRSA), and vancomycin-resistant enterococcus (VRE). Illnesses caused by these bacteria are among the most common health care-acquired infections in the United States, affecting one in 10 patients, killing approximately 90,000 individuals and costing between $5 billion and $11 billion annually, says Pronovost.

CUSP is a collaborative effort between Johns Hopkins' Quality and Safety Research Group, the Health Research & Educational Trust and the Michigan Health & Hospital Association Keystone Center for Patient Safety and Quality. Funding comes from the Agency for Healthcare Research and Quality, the Sandler Foundation of the Jewish Community Endowment Fund and an anonymous donor.

Pronovost, a recipient of the MacArthur "genius" grant, was named one of the world's "most influential people" of 2008 by Time magazine for his work in patient safety.

The magazine's annual list recognizes people "whose power, talent or moral example is transforming our world."

Hopkins Quality and Safety Research Group:
http://www.safetyresearch.jhu.edu

Hopkins Center for Innovation in Quality Patient Care:
http://www.hopkinsquality.com/cfi/default.asp