eliminating clabsi, a national patient safety imperative: final report.

How many deaths can be prevented by using the CLABSI model?

To estimate the deaths prevented, a range in mortality was assumed (12-25 percent). 11 For each 100 CLABSIs prevented, 12-25 deaths are prevented. To estimate the excess costs averted, the mean cost per CLABSI (using CPI inpatient hospital service adjustment) was utilized: $70,696.

What are the learning objectives of CLABSI prevention?

Learning Objectives • Outline the Tier 2 interventions to prevent CLABSI • Describe when implementation of Tier 2 interventions may be necessary • Identify strategies to overcome barriers to CLABSI prevention interventions 3 Tiers of CLABSI Prevention* 4 Multidisciplinary Rounds Diverse perspectives improve decision-making

Where can I find guidelines or indications for CLABSI prevention?

Indications for use may also be found on the CDC website for CLABSI prevention. Having written guidelines or indications may provide guidance and support when there is disagreement among clinicians. 38 Speaker Notes: Slide 11

How effective is training for CLABSI prevention during catheter insertion?

CLABSI rates decreased from 3.82 per 1,000 catheter days to 1.29 per 1,000 catheter days when comparing the 23 months before the training and 21 months after the training. This study underscores the importance of knowing and following evidence- based practice for CLABSI prevention during insertion.

What did the NPT learn?

The NPT learned to be flexible in responding to the changing environment at all levels—from the national level to the unit level. This manifested itself in how the NPT advised States on monthly State lead calls and in using faculty from HHS and CDC to present to unit teams and at State lead meetings. States and unit teams worked to adapt, coordinate, and integrate other improvement techniques and tools such as TeamSTEPPS®, Just Culture, Lean, and Six Sigma programs with the CUSP efforts.

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.

What are the results of the CUSP: Stop BSI?

The results of On the CUSP: Stop BSI demonstrate that MHA Keystone and the Armstrong Institute had developed an education and coaching program that could be scaled up nationally. The ability of MHA Keystone to clearly articulate what worked in their State was also extremely important. Knowing that a peer organization could and did achieve success encouraged other States/regions to try this in their home territory.

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.

Do hospitals and regions have the same level of knowledge, attitudes, and skills?

Hospitals and regions do not all begin improvement efforts with the same level of knowledge, attitudes, and skills, and it became apparent early on in the project that the NPT needed to accommodate these differences.

What is the CUSP toolkit?

A key sustainability resource is the CUSP Toolkit, which will be released after the AHRQ annual conference in September 2012. The Toolkit was designed for State leads and hospital unit staff to successfully design and implement a CUSP-based initiative. It demonstrates how CUSP works with existing patient safety frameworks such as TeamSTEPPS, Just Culture, and Sensemaking. The CUSP Toolkit is comprised of slide sets, facilitator notes, exercises, and videos. The videos include scripted vignettes, informational presentations, and interviews with CUSP teams. The toolkit was piloted among State leads to obtain feedback on clarity of content and ease of use.

What is the importance of NPT?

The NPT has emphasized the importance of States and regions having adequate numbers of staff trained in QI and patient safety, preferably individuals with a clinical background, in addition to project management skills. For the past several months the NPT has encouraged States and regions to prepare for the project’s end by monitoring CLABSI data captured in NHSN or in State-specific databases. HRET is currently asking States and regions if they require extended use of the MHA Keystone Care Counts database to monitor CLABSI rates while they create their own State or regional database if none currently exists.

What are some examples of successful states?

Examples included taking the CUSP and CLABSI manuals and breaking them down into smaller sections for the teams to assimilate. Other States took the time to walk their teams through the project website, which seemed overwhelming to many teams, particularly when they were getting started.

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.

What are some examples of NPT?

Examples of how the NPT addressed local and special needs included holding Critical Access and Long-term Acute Care affinity group calls, developing a neonatal CLABSI elimination collaborative and holding conference calls on central line maintenance which surpassed line insertion as the biggest opportunity for CLABSI reduction. The NPT also made itself available to States and regions with less regional quality improvement experience, limited staff and/or those without clinical backgrounds. State leads in States with a history of successful quality improvement collaboratives were asked to share their experiences and resources with other States and asked their unit teams to present on national calls. In the case of Puerto Rico, it soon became apparent that Spanish translation services were needed on monthly coaching calls and that the CUSP Manual and CLABSI Elimination Toolkit needed to be translated into Spanish. The ―Science of Safety‖ video was also made available in Spanish to support staff from participating Puerto Rican units.

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.

How does NPT promote sustainment?

The NPT has promoted sustainment in each State and region by training State association leads and other association staff in the CUSP model and methodology alongside their hospital units. Each month State leads were exposed to coaching techniques by the Armstrong Institute and MHA Keystone faculty advisors assigned to their State/region, and then weaned off the MHA Keystone advisors at month 9, and the Armstrong Institute advisors at month 18. After this point State leads led the coaching calls on their own.

Have Well-Defined, Evidence-Based Interventions

Build A Solid Implementation Structure and Project Plan

Collect and Use Timely, Accurate, and Actionable Data to Improve Performance

Tailor National Program For Local and Unit Audiences

Evolve Project Strategies and Emphases Over Time

• Work with Late Adopters
  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 …
• Seek New Opportunities to Reduce CLABSI
  As rates declined, the NPT, States/regions, and unit teams looked for opportunities to reach zero CLABSIs. This included changing focus on central line insertion to central line maintenance and disseminating guidelines on dressing changes and hub scrubbing. It involved disseminating CU…

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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

Table 12. Cost Per CLABSI of Studies Meeting Inclusion Criteria*