287. Using the Comprehensive Unit-based Safety Program (CUSP) Model for Sustained Reduction in Hospital Infections
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Drees_CUSP_MICUWICU_IDWeek2015_FINAL.pdf (929.5 kB)
  • Background: Prompted by high central line-associated bloodstream infection (CLABSI) rates, our institution joined the national On the CUSP: Stop BSI initiative.  The multidisciplinary CUSP model guides patient care units in reducing multiple different types of infections and other safety problems.  We report the significant and sustained impact that CUSP has had in reducing not only CLABSI but catheter-associated urinary tract infections (CAUTI) and other safety problems in two intensive care units (ICUs).

    Methods: At our 2-hospital, 1100-bed community-based academic health care system, a 22-bed medical ICU and 9-bed medical-surgical ICU implemented CUSP as part of a 2-year statewide initiative.  The units implemented the CUSP tools but also developed local interventions to first reduce CLABSI then address other safety issues.  Systemwide CLABSI technology solutions included chlorhexidine-impregnated sponge dressings and alcohol-based cleaning devices for central line hubs.  We measured CLABSI and CAUTI over 6 years, divided into baseline (1/09-6/10), CUSP project (7/10-6/12) and post-CUSP (7/12-12/14) periods, using NHSN definitions, and calculated standardized infection ratios (SIRs). 

    Results: CLABSI decreased from 3.9 per 1000 catheter-days at baseline to 0.6/1000 during the post-CUSP period (rate ratio 0.16, 95% CI 0.07-0.35), and the CLABSI SIR decreased from 0.8 (95% CI, 0.5-1.4) to 0.2 (95% CI, 0.1-0.5).  CAUTI improved from 3.6 per 1000 catheter-days at baseline to 2.1/1000 (rate ratio 0.6, 95% CI 0.3-1.1), and from 2.4 per 1000 patient-days to 1.0/1000 (rate ratio 0.4, 95% CI 0.24-0.65).  The CAUTI SIR decreased from 1.1 (95% CI, 0.5-2.1) to 0.9 (95% CI, 0.5-1.6).  Device utilization decreased significantly in both ICUs. Ventilator-associated pneumonia and patient falls decreased as well.

    Conclusion: Implementation of CUSP, as exemplified by these 2 ICUs, was associated with significant decreases in CLABSI and CAUTI.  CAUTI improvements, for which a major intervention was earlier device removal, was better reflected by tracking infections per patient-days rather than per device-days or by the SIR.  The CUSP model, allowing for both implementation of evidence-based practices as well as learning from frontline staff, can create sustainable improvements that reach far beyond the initial targeted safety problem.

    Kristen Miller, DrPh, MSPH1, Lorraine Adkins, BSN, RN, CIC2, Michael Benninghoff, DO2, Carol Briody, MT (ASCP), CIC2, Donna Casey, BSN, MA, RN, FABC, NE-BC2, Nancy Davis, BSN, RN, CIC2, Robert Dressler, MD, MBA1,2, Jill K. Kane, BSN, RN, CCRN2, Amy Llewellyn, BSN, RN, CCRN2, Vinay Maheshwari, MD2, Dannette Mitchell, MSN, APRN, ACNS-BC, CCRN2, Badrish Patel, MD2, Carol Ritter, MSN, RN, CCRN, CNML2, Maureen Seckel, APN, MSN, ACNS-BC, CCNS, FCCM2, Sandy Wakai, MSN, RN, CCRN2, Kathleen Wroten, MSN, RN, CIC2 and Marci Drees, MD, MS1,2, (1)Value Institute, Christiana Care Health System, Newark, DE, (2)Christiana Care Health System, Newark, DE

    Disclosures:

    K. Miller, None

    L. Adkins, None

    M. Benninghoff, None

    C. Briody, None

    D. Casey, None

    N. Davis, None

    R. Dressler, None

    J. K. Kane, None

    A. Llewellyn, None

    V. Maheshwari, None

    D. Mitchell, None

    B. Patel, None

    C. Ritter, None

    M. Seckel, None

    S. Wakai, None

    K. Wroten, None

    M. Drees, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.