Using the Comprehensive Unit-based Safety Program model for sustained reduction in hospital infections

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• 作者：Kristen Miller ; DrPh ; MSPH^a ; ^{Krmiller@christianacare.org" class="auth_mail" title="E-mail the corresponding author} ; Carol Briody ; MT (ASCP) ; CIC^b ; Donna Casey ; BSN ; MA ; RN ; FABC ; NE-BC^c ; Jill K. Kane ; BSN ; RN ; CCRN^d ; Dannette Mitchell ; MSN ; APRN ; ACNS-BC ; CCRN^e ; Badrish Patel ; MD^d ; Carol Ritter ; MSN ; RN ; CCRN ; CNML^d ; Maureen Seckel ; APN ; MSN ; ACNS-BC ; CCNS ; FCCM^d ; Sandy Wakai ; MSN ; RN ; CCRN^f ; Marci Drees ; MD ; MS^a ; ^b
• 关键词：Comprehensive Unit&ndash ; based Safety Program ; catheter infections ; bloodstream infections ; safety culture
• 刊名：American Journal of Infection Control
• 出版年：2016
• 出版时间：1 September 2016
• 年：2016
• 卷：44
• 期：9
• 页码：969-976
• 全文大小：1305 K

文摘

Prompted by the high number of central line–associated bloodstream infections (CLABSIs), our institution joined the national On the CUSP: Stop BSI initiative. We not only report the significant impact that the Comprehensive Unit-based Safety Program (CUSP) had in reducing CLABSI, but also report catheter-associated urinary tract infections (CAUTIs) and ventilator-associated pneumonia (VAP) in 2 intensive care units (ICUs).

Methods

At our community-based academic health care system, 2 ICUs implemented CUSP tools and developed local interventions to reduce CLABSI and other safety problems. We measured CLABSI, CAUTI, and VAP during baseline, the CUSP period, and a post-CUSP period.

Results

CLABSIs decreased from 3.9 per 1,000 catheter days at baseline to 1.2 during the CUSP period to 0.6 during the post-CUSP period (rate ratio, 0.16; 95% confidence interval [CI], 0.07-0.35). CAUTIs decreased from 2.4 per 1,000 patient days to 1.2 during the post-CUSP period (rate ratio, 0.4; 95% CI, 0.24-0.65). VAP rate decreased from 2.7 per 1,000 ventilator days to 1.6 during the CUSP and post-CUSP periods (rate ratio, 0.58; 95% CI, 0.30-1.10). Device utilization decreased significantly in both ICUs.

Conclusions

Implementation of CUSP was associated with significant decreases in CLABSI, CAUTI, and VAP. The CUSP model, allowing for implementation of evidence-based practices and engagement of frontline staff, creates sustainable improvements that reach far beyond the initial targeted problem.