a national patient safety imperative: final report”, january 2013

by Raegan Bergstrom 7 min read

Eliminating CLABSI, A National Patient Safety Imperative: …

13 hours ago Armstrong Institute, and MHA Keystone staff comprised the national project team (NPT) which named the national initiative, On the CUSP: Stop BSI. line days, and 2) to improve patient safety culture on hospital units. Each State and regional hospital association executive signed a letter committing to these goals, to assigning a staff >> Go To The Portal

What was the goal of the NPT to reach zero CLABSI?

This included changing focus on central line insertion to central line maintenance and disseminating guidelines on dressing changes and hub scrubbing. It involved disseminating CUSP and CLABSI elimination interventions to different areas of the hospital such as non-ICUs and hemodialysis units, and focusing on special patient populations such as those who were immuno-suppressed.

How many states did the NPT work with?

The NPT learned several lessons in doing this work, both through its own experience working over four years with 46 States and regions, as well as through in-depth interviews conducted in May and June 2012 with 11 State leads.

How long did the CUSP stop BSI take?

On the CUSP: Stop BSI was a multi-phase effort spanning four years. Over that time, there were changes that required the NPT to adjust its strategies and emphases. The knowledge, skills, and attitudes of the State and regional participants changed over time. For example, the last cohort of States did not consist of early adopters, and they needed additional support. The NPT met frequently to try to address the lower level of engagement of these State leads and their unit teams. And while no particular solution was developed, the NPT did attempt to focus on the ―late majority‖ and ―laggards‖ of the Rogers Innovation Adoption Curve with a ―higher intervention technique with more frequent tracking and communication and coaching services.‖9

What is the importance of national experts?

Having highly credible national experts with proven ability to achieve project goals is a critical element of any successful national quality improvement campaign, and this was certainly the case with On the CUSP: Stop BSI. All State leads interviewed by HRET stated that the national expertise and leadership of members of the NPT was a primary factor in their recruitment to this program.


On the CUSP: Stop BSI was an unprecedented national improvement collaborative that demonstrated that a national program could be replicated in multiple States and regions from one successful State implementation.

Table of Contents

On the CUSP: Stop BSI was an unprecedented national improvement collaborative that demonstrated that a national program could be replicated in multiple States and regions from one successful State implementation.

Section Summary

Over 1,000 hospitals registered for participation in the study, with over 1,800 total units represented.

Hospital Characteristics

In order to be included in the examination of hospital characteristics, registered hospitals had to have completed the 2010 American Hospital Association (AHA) Annual Survey, and hospitals had to respond to variables of interest. A total of 934 hospitals could be matched to their AHA Annual Survey results (86 percent).

Unit Characteristics

The majority of registered units were adult ICUs although some adult non-ICUs and pediatric units did participate ( Figure 2 ). A total of 237 units formally withdrew from the initiative (101 ICU, 130 Non-ICU, 6 pediatric). A statistically significant larger proportion of non-ICUs withdrew from the project than ICUs or pediatric units ( p <0.001).

Data Submission

Participating units were requested to submit 12 consecutive months of baseline CLABSI data prior to their cohort start date and 18 consecutive months post-baseline for a total of 30 data points. On average, units submitted 76 percent of the CLABSI data requested.

Project Penetration

A total of 935 hospitals participating self-identified as having an ICU (data obtained from project registration, not AHA Annual Survey). This represents approximately 29 percent of hospitals with ICUs in the country (approximately 3,200 hospitals with ICUs nationally based on the 2010 AHA Annual Survey).


Infections Avoided, Excess Costs Averted, and Changes in Mortality Rate

  • Section Summary
    1. The project carried out a systematic review of the cost of CLABSI. After reviewing almost 850 abstracts and over 150 articles in full, 6 articles met inclusion criteria. 2. After weighting and adjusting to 2012 dollars, the average CLABSI cost reported in the literature was $70,696 with a …
  • Literature Review—Methods
    PubMed, EconLit, Biological Abstract and Science Direct were searched. First, articles were reviewed at the abstract level. Abstracts believed to have appropriate CLABSI cost calculations were retrieved to be reviewed in full. Retrieved articles were then reviewed against inclusion crite…
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Table 11. Articles Satisfying Inclusion Criteria

  • Although stringent inclusion/exclusion criteria were applied, the six included articles differed significantly in both estimated costs as well as the methods utilized to derive the costs. Variation can be attributed to factors such as sample size (range: 12-100,851 cases), setting (single hospital site estimate in four studies vs. multi-site estimate), costs considered (e.g., costs billed…
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Table 12. Cost Per CLABSI of Studies Meeting Inclusion Criteria*

  • * All consumer price indexes utilized May 2012 tables. † Cases reflect the number of observed CLABSIs utilized in the study's cost estimate. CPI-U = all urban consumer price index; CPI IP = consumer price index inpatient hospital services index
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