OutBox

Supporting Change

By John R. Combes, M.D.

Dramatically reducing health care-associated infections through evidence-based tools

Each year, an estimated 250,000 cases of central line-associated bloodstream infections (CLABSI) occur in U.S. hospitals. It was once thought that these infections were the price to be paid for placing central venous catheters in hospitalized patients. Peter Pronovost, M.D., his team at Johns Hopkins University and the Michigan Health & Hospital Association proved that notion wrong.

The Comprehensive Unit-based Patient Safety Program (CUSP) started by Pronovost in a few intensive care units at JHU is a powerful weapon against CLABSI and other types of health care-associated infections. CUSP, which combines proven patient safety techniques with a systematic focus on safety culture, was embraced by the MHA leadership and implemented in more than 100 ICUs of the association’s member hospitals. Within three months of implementation, the program helped reduce infection rates to zero in more than 50 percent of participating hospitals. For the past four years, Michigan hospitals have dramatically reduced these infections in the ICU and have also built a culture of safety. But the innovation hasn’t stopped there. This success led Michigan hospitals to use CUSP in other areas of the hospital, including the operating room and emergency department, where catheters are inserted.

Though these infections are largely preventable, changing behavior to avert them is not easy. The Agency for Healthcare Research and Quality is supporting that change with CUSP’s effective combination of tools and safety culture emphasis. AHRQ, with in-kind support from the American Hospital Association, is funding the Health Research & Educational Trust and our JHU and MHA partners to replicate CUSP in 10 states and at least 10 hospitals within each state over a three-year period.

AHRQ’s approach is noteworthy. First, it has chosen an important safety topic that hospitals can rally around. Second, hospitals will get the necessary evidence-based tools to virtually eliminate CLABSI. Third, this new project will promote rapid and broad-based spread by involving at least 100 hospitals.

Hospitals are continually asking for proven methods to improve performance and for help implementing them to achieve maximal results. This project provides those methods and that help. Starting with 10 states, we will learn how to implement the CUSP program in diverse settings so it can then be spread across all 50 states.

Michigan hospitals are saving an estimated 1,500 to 1,800 lives a year, eliminating an estimated $200 million in excess costs annually. Just think what we can do when we multiply that success by 10 states, and then by 50. Patients and their loved ones will breathe easier knowing that programs like CUSP are being systematically put into place in our hospitals.

For more information on CUSP, visit www.hret.org.

John R. Combes, M.D., is interim president, HRET, and president and chief operating officer of the AHA Center for Healthcare Governance.

You can contact our guest author at jcombes@aha.org.

This article 1st appeared in the November 2008 issue of HHN Magazine.

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