QIOs Adopting CUSP to Fight Healthcare-Associated Infections

The Centers for Disease Control and Prevention (CDC) estimates 31,000 people die each year from Healthcare-Associated Infections (HAI) caused by improper care of catheters inserted before major surgery, chemotherapy or dialysis. It is estimated that HAIs cause $28 to $33 billion in avoidable healthcare costs annually.

These staggering statistics make the prevention and reduction of HAIs a top priority for the U.S. Department of Health and Human Services (DHHS). International patient safety leader Peter J. Pronovost, M.D., Ph.D., is deeply involved in this effort and works closely with CMS. He has authored more than 200 articles and chapters in the fields of patient safety, quality health care, evidence-based medicine and the measurement of safety efforts. He was also named one of the world’s “most influential people” of 2008 by Time magazine for his work in patient safety.

As part of a larger collaborative effort to prevent and ultimately eliminate HAIs throughout the nation, a number of QIOs are currently partnering with Dr. Pronovost and a consortia of state hospital associations, public health agencies and participating hospitals to implement a patient safety program proven to reduce HAIs, the Comprehensive Unit-Based Safety Program (CUSP).

Spreading Best Practices Throughout the Nation

The CUSP initiative builds upon best practices implemented at 100 hospitals within 70 health organizations across the state of Michigan to reduce catheter-related bloodstream infections. The Michigan hospitals implemented a protocol developed at Johns Hopkins that is now included in the CUSP manual and toolkit, which provide the basis for all CUSP project activities and data collection.

Dr. Pronovost cites a general lack of standardized safety measures for catheter insertion as one of the most common causes of HAIs. Based on this premise, Dr. Pronovost and his team developed a checklist to standardize safe methods for catheter insertion and removal:

• Always wash hands
• Clean skin with chlorhexidine
• Avoid placing catheters in groin whenever possible
• Cover yourself and the patient during surgery
• Make sure the field is sterile
• Reassess daily whether catheterization is still necessary

Dr. Pronovost also recommends designating a mobile cart for all catheter supplies and appointing a staff member to ensure the cart is fully stocked at all times. The easily accessible cart eliminates opportunities for staff members to skip safety measures or breach their sterilized field to retrieve supplies.

Dr. Pronovost also notes that the hierarchical and often competitive structure within hospital systems contributes to the development of HAIs by overshadowing a culture which should be primarily focused on patient safety. In order to foster the open communication among all levels of health professionals that is so essential to patient safety, Dr. Pronovost says hospitals must transform their work environment to one that is cooperative, interdependent and results-focused. As was the case at Johns Hopkins and many of the Michigan hospitals, staff may initially challenge a culture shift; for example, empowering nurses to speak up when physicians fail to follow the checklist. Such resistance can be overcome, however, by training staff in effective team communications and uniting nurses and physicians around the common goal of ensuring patient safety.