Expanding the Comprehensive Unit-based Safety Program (CUSP) to reduceCentral Line-Associated Blood Stream Infections (CLABSI) and Catheter-Associated Urinary Tract Infections (CAUTI) in Intensive Ca

DHHS Action Plan to Prevent Healthcare-Associated Infections In January 2009, the Department of Health and Human Services (HHS) released the first iteration of the National Action Plan to Prevent Healthcare-Associated Infections (HAI NAP). The HAI NAP was developed by the HHS Office of Public Health and Science, AHRQ, Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), and other offices and operating divisions of HHS. As part of the Department of Health and Human Services (DHHS) National Action Plan (NAP) to Prevent Healthcare-Associated Infections (HAI), AHRQ has supported the implementation and adoption of the Comprehensive Unit-based Safety Program (CUSP) to reduce Central-Line Associated Bloodstream Infections (CLABSI) and Catheter-Associated Urinary Tract Infections (CAUTI), and is applying the principles and concepts that have been learned from these HAI reduction efforts to ICUs with persistently elevated infection rates. Results of Implementation of CUSP for CLABSI and CAUTI The nationwide CUSP for CLABSI project implemented CUSP with ICU teams at more than 1,100 adult ICUs in 44 states over a 4-year period. ICUs participating in this project reduced the rate of CLABSIs nationally from 1.915 infections per 1,000 central line days to 1.133 infections per 1,000 line days, an overall reduction of 41 percent. However, not all ICUs performed equally well. The CUSP for CAUTI project implemented CUSP in nine cohorts, representing over 1,600 hospital units in over 1,200 hospitals located across 40 states, the District of Columbia, and Puerto Rico. Inpatient CAUTI rates in non-ICUs were decreased by 30%. However, CAUTI rates in ICUs were not reduced significantly. In other words, while the overall results of the implementation of CUSP for CLABSI and CUSP for CAUTI have shown remarkable progress, not all ICUs in the projects have achieved the intended rate reductions, nor have all ICUs participated in the two projects. Moreover, a significant number of institutions and ICUs continue to have persistently elevated infection rates. There are institutions that have varying rates of infections within the same institution indicating that infection control is often a unit-based issue. In sum, despite the significant overall reductions in CLABSI and CAUTI rates that have been achieved in these two projects, there is evidence that ICUs have generally faced challenges in reducing CAUTI rates, and that many hospitals still are not where they should be in CLABSI rates. Modified approaches and strategies for the CUSP intervention need to be developed and implemented to reach ICUs with persistently elevated CLABSI and CAUTI rates and help them succeed in preventing these infections. To address this need, AHRQ will launch this project aimed at spreading nationally implementation of an adaptation of CUSP for CLABSI and CAUTI for ICUs with persistently elevated rates, optimizing the approach to maximize effectiveness, and further preventing these infections throughout the United States. This project has the following goals: • Reduce central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) in ICUs with persistently elevated rates. • Revise and augment current CUSP training resources and materials for CUSP for CLABSI and CAUTI in ICUs with persistently elevated rates. The resulting toolkit will be intended for use in ICUs whose infection rates for either or both of these HAIs are persistently elevated compared to other ICUs. • Recruit 450-600 ICUs with persistently elevated rates nationally to demonstrate the utility of applying a modified CUSP for CLABSI and CUSP for CAUTI during the performance period to reduce rates of CLABSI and CAUTI in these ICUs. • Assess the adoption of the modified CUSP for CLABSI and CAUTI and evaluate the effectiveness of the intervention in the participating ICUs

The latest form for Expanding the Comprehensive Unit-based Safety Program (CUSP) to reduceCentral Line-Associated Blood Stream Infections (CLABSI) and Catheter-Associated Urinary Tract Infections (CAUTI) in Intensive Ca expires 2021-04-30 and can be found here.

Attachment A: ICU Assessment

Federal Enterprise Architecture: Health - Health Care Services

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