Hospital’s Neonatal Intensive Care Units (NICU) participating in the AHRQ patient safety program have seen a sharp drop in Central Line Associated Bloodstream Infections (CLABSI). Caregivers in 100 NICUs in nine states used the program’s prevention practice checklist and better communication skills to prevent an estimated 131 infections, prevented up to 41 deaths, and avoided more than $2 million in healthcare costs.
CLABSIs are healthcare-associated infections that cause serious illness and death in infants as well as adults. A central line is a tube (catheter) that goes into a patient’s vein or artery and ends in the central bloodstream. In newborns especially with premature infants, central lines can remain in place for week or months to provide nutrients and medications as babies become able to function on their own.
Healthcare teams in the eleven month project in the states cared for 8,400 newborns using AHRQ’s Comprehensive Unit-Based Safety Program (CUSP) to improve safety culture and to consistently implement catheter insertion and maintenance guidelines.
AHRQ provided funding to the Health Research & Educational Trust (HRET), the educational arm of the American Hospital Association, to conduct the project. For the NICU project, the HRET partnered with the Perinatal Quality Collaborative of North Carolina and the Missouri Center for Patient Safety to support projects in Colorado, Florida, Hawaii, Massachusetts, Michigan, New Jersey, North Carolina, South Carolina, and Wisconsin.
Each state-based team was led by a neonatologist who worked with the state’s hospital association to implement the project. When the project began, participating NICUs had an overall infection rate of 2,043 per 1,000 central line days. At the end of the project that rate was reduced by 58 percent.
The concept of CUSP was first developed by Peter J. Pronovost, M.D. PhD, Director of the Armstrong Institute and Senior Vice President for Patient Safety and Quality at Johns Hopkins University with funding from AHRQ. It was first tested statewide in over 100 adult ICUs in Michigan hospitals and then expanded to other states. Today, many hospitals nationwide are using CUSP as a result.