Wake Forest University Baptist Medical Center (WFUBMC) BSI Reduction as part of the North Carolina (NC) Safer ICUs: Eliminate CLABSI Collaborative

Background: The recent dramatic improvement in BSI in Michigan ICUs (NEJM 2006;355:2725) employing the Comprehensive Unit Based Safety Program (CUSP) approach developed by Johns Hopkins University Quality & Safety Research Group (JHU) led to federal Agency for Healthcare  Research and Quality funding to expand the program to 10 additional states with NC part of the first cohort.  The NCCHQPS, in partnership with JHU, Keystone Center for Patient Safety and Quality of the Michigan Health & Hospital Association, and the American Hospital Association’s Health Research and Education Trust, led the NC Safer ICUs: Eliminating CLABSI Collaborative.

Objective: To determine if the MHA Keystone ICU project could be successful in a large teaching hospital in NC and replicated in 30 other hospital units in N.C.

Methods: Beginning in March 2009 40 ICUs in 27 hospitals (108 total hospitals in NC) began participating in biweekly coaching/content calls to teach ICU staff how to use the CUSP approach to preventing BSI. Baseline data were submitted from all 40 ICUs (10 from WFUBMC) and then the CUSP intervention began formally in July 2009. In addition to the CUSP intervention, many hospitals utilized other interventions as well. At WFUBMC, the following additional interventions took place: chlorhexidine gluconate daily bathing, changed to Microclave catheter hubs, emphasized two peripheral blood cultures (BC) as preferred over any BC drawn through catheter lumens, sent each ICU each BSI identified by Infection Control as soon as it was called, approved institutional goals of BSI <50% NHSN by June 2011 and <25% NHSN by June 2012. All ICU QI groups met monthly, individually and as a group.

Results:

Preliminary results show a 48% BSI reduction in the 40 participating ICUs with a baseline (Oct 2008 to June 2009) aggregate BSI rate of 2.5/1000 dd decreasing to a rate of 1.3/1000 dd.  At WFUBMC our one year baseline rate for our 10 adult ICUs was 4.67/1000 dd which declined to an aggregate rate of 2.66/1000 dd during the next 15 months (P=0.0007) and a rate of 1.3/1000 dd in the last 6 of those months (P=0.000003). At WFUBMC the median BSI rate for 10 adult ICUs was 1.0/1000 dd and 5/10 ICUs have had no BSIs in ≥ 3 months. At the SHEA meeting additional details will be provided about lessons learned at WFUBMC from the NC BSI reduction collaborative.

Conclusions: Our interim analysis clearly suggests that the CUSP approach has led to dramatic improvement in BSI at WFUBMC and among the NC collaborative participating units. Subject to more rigorous validation of BSI detection methodologies, etc. these data lend additional credence to the idea that the CUSP approach to process improvement is an efficacious methodology for preventing HAIs.