title: Using the Comprehensive Unit-based Safety Program model for sustained reduction in hospital infections.
abstract: 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).
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Value Institute, Christiana Care Health System, Newark, DE. Electronic address: Krmiller@christianacare.org.
authors.forename: Kristen
authors.initials: K
authors.lastname: Miller
authors.affiliation: Infection Prevention, Christiana Care Health System, Newark, DE.
authors.forename: Carol
authors.initials: C
authors.lastname: Briody
authors.affiliation: Patient Care Services, Cardiovascular and Critical Care, Christiana Care Health System, Newark, DE.
authors.forename: Donna
authors.initials: D
authors.lastname: Casey
authors.affiliation: Medical ICU, Christiana Care Health System, Newark, DE.
authors.forename: Jill K
authors.initials: JK
authors.lastname: Kane
authors.affiliation: Medical ICU, Wilmington Hospital, Wilmington, DE.
authors.forename: Dannette
authors.initials: D
authors.lastname: Mitchell
authors.affiliation: Medical ICU, Christiana Care Health System, Newark, DE.
authors.forename: Badrish
authors.initials: B
authors.lastname: Patel
authors.affiliation: Medical ICU, Christiana Care Health System, Newark, DE.
authors.forename: Carol
authors.initials: C
authors.lastname: Ritter
authors.affiliation: Medical ICU, Christiana Care Health System, Newark, DE.
authors.forename: Maureen
authors.initials: M
authors.lastname: Seckel
authors.affiliation: Joint Replace Center, Wilmington Hospital, Wilmington, DE.
authors.forename: Sandy
authors.initials: S
authors.lastname: Wakai
authors.affiliation: Value Institute, Christiana Care Health System, Newark, DE; Infection Prevention, Christiana Care Health System, Newark, DE.
authors.forename: Marci
authors.initials: M
authors.lastname: Drees
mesh_terms: D000046:Academic Medical Centers; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D006302:Health Services Research; D006801:Humans; D017053:Infection Control / Q000379:methods*; D061214:Patient Safety; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control; D018805:Sepsis / Q000517:prevention & control*; D014552:Urinary Tract Infections / Q000517:prevention & control
keywords: Comprehensive Unit–based Safety Program; bloodstream infections; catheter infections; safety culture