CUSP Program Reduced ICU Bloodstream Infections by 40 Percent

The Comprehensive Unit-based Safety Program (CUSP), funded by the Agency for Healthcare Research and Quality (AHRQ), resulted in a 40 percent reduction in the rate of central line-associated bloodstream infections (CLABSIs) for intensive care units (ICUs), amounting to over 2,000 less infections, 500 lives spared, and $34 million in health care savings. When the findings of CUSP were discussed at the annual AHRQ conference last week among partners from the American Hospital Association (AHA) and Johns Hopkins Medicine, AHRQ Director, Carolyn M. Clancy, M.D., stated, “This project gives us a framework for taking research to scale in practical ways that help front-line clinicians provide the safest care possible for their patients.”

Healthcare-associated infections (HAIs), or infections contracted in a healthcare setting while patients receive treatment for another condition, are of serious concern in the healthcare industry.  HAIs are caused by bacteria, fungi, viruses, and other pathogens, and are often associated with (1) indwelling medical devices like bloodstream, endotracheal, and urinary catheters; (2) surgeries; (3) injections; (4) contamination of the healthcare setting; (5) transmission of diseases between patients and healthcare workers; and (6) antibiotic overuse or misuse.  HAIs are most often urinary tract infections, surgical site infections, bloodstream infections, and pneumonia and affect one of every 20 patients in a hospital at a given time. No healthcare setting is immune to the risk of HAIs; inpatient acute care hospitals, outpatient departments like ambulatory surgery centers and end-stage renal disease facilities, as well as long-term care facilities like nursing homes and rehabilitation centers are all affected.

The national CUSP program was conducted over a four-year period, bringing together hospital teams at more than 1,100 adult ICUs in 44 states.  The first major application of CUSP was successfully completed in Michigan, assisted by the Michigan Health & Hospital Association, and was then expanded to 10 states, and then nationally by the Health Research & Educational Trust. The preliminary results from the program showed a reduction of CLABSIs nationally from 1.903 infections to 1.137 infections per 1,000 central line days, amounting to a 40 percent reduction. 

CUSP stresses the need for communication, teamwork, and leadership to protect patient safety, specifically evidence-based safety practices, staff training, consistent measurement of infection rates, engagement of leadership, and tools to improve teamwork among the health care team. The five steps listed below are meant to arm providers with the necessary tools, metrics and framework to achieve the goals of CUSP:

  • Step 1. Staff are educated on the science of safety.
  • Step 2. Staff complete an assessment of patient safety culture.
  • Step 3. A senior hospital executive partners with the unit to improve communications and education leadership.
  • Step 4. Staff learn from unit defects.
  • Step 5. Staff use tools, including checklists, to improve teamwork, communication, and other systems of work. 

CUSP is not the only program aimed at preventing HAIs; the Centers for Disease Control and Prevention  (CDC) and HHS’ National Action Plan to Prevent Healthcare Associated Infections and the Partnership for Patients are also part of the coordinated HHS approach to protect patients from infections.  For more information on CUSP, please visit