Frontline teamwork, safety practices slice hospital infection rate by 40%

By Sarah Guy, medwireNews Reporter

Implementation of the Comprehensive Unit-based Safety Program (CUSP) has reduced the rate of central line-associated bloodstream infections (CLABSIs) by 40% in more than 1100 US intensive care units (ICUs), reports the agency that funded the program.

The Agency for Healthcare Research and Quality (AHRQ) funded CUSP in 44 US states over 4 years, in which time the number of CLABSIs dropped from 1.903 to 1.137 infections per 1000 central line days.

"Until recently, these infections were thought to be an [unavoidable] consequence of care," said Carolyn Clancy, Director of the AHRQ, at a press briefing, adding that "no patient should ever become sicker as a result of care he or she receives."

Clancy explained that CLABSIs kill almost as many patients per year as does breast and prostate cancer, but that implementing CUSP has wiped out infection rates almost entirely in some US hospitals. In Michigan, more than 65% of hospitals went 1 year between the period 2003 to 2005 without any CLABSIs at all, she added.

CUSP's basic concepts are to teach staff best practices for avoiding CLABSIs, to ensure the involvement of the entire staff, to "execute" the program, and to keep track of results and feed them back to staff.

Peter Provost (Johns Hopkins, Baltimore, Maryland), one of the developers of CUSP who spoke at the press briefing, said that its success so far is a result of it being "led by frontline doctors, nurses, and administrators working as part of a CUSP team, believing this was their problem and knowing they were capable of solving it."

Indeed, one of the functions of CUSP is to initiate a "unit-based culture change" where physicians, nurses, and others are partnered to implement practices, explained American Hospital Association president Rick Umbdenstock.

The reduction in CLABSIs seen in the ICUs already implementing CUSP equates to more than 500 lives saved and 2000 infections avoided, as well as the spending of approximately US$ 34 million (€ 26 million) being avoided, noted Clancy at the briefing.

The CUSP toolkit is available to any hospital, can be adapted to suit any particular hospital environment, and includes an explanation of the framework and its goals, as well as checklists and videos demonstrating how to apply it in a clinical environment.

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