Award Date


Degree Type


Degree Name

Doctor of Nursing (ND)



First Committee Member

Jessica Doolen

Second Committee Member

Susan VanBeuge

Third Committee Member

Christopher Cochran

Number of Pages



Central line-associated bloodstream infections (CLABSIs) are one of the most significant healthcare-associated infections (HAIs) in the Intensive Care Unit (ICU) setting resulting in increased lengths of stay, increased healthcare costs, and higher mortality rates (Institute of Healthcare Improvement [IHI], 2012). Evidence that CLABSIs are largely preventable has created opportunities for healthcare organizations to implement evidence-based bloodstream infection prevention practices to reduce or eliminate these infections (Lissauer, Leekisa, Prease, Thom, & Johnson, 2012). Other efforts to reduce CLABSIs include implementation of safety programs to improve the safety culture in ICUs (Lissauer et al., 2012). One program, the comprehensive unit-based safety program (CUSP), was developed to improve the safety culture within ICUs and achieve the goal of reducing or eliminating CLABSIs (Pronovost et al., 2006). The CUSP is a framework designed to educate and improve awareness of patient safety and quality of care for nurses, physicians, and other bedside care providers through a five step process (Agency for Healthcare Research and Quality [AHRQ], 2011). The five steps of the CUSP program are: (1) educate on the science of safety; (2) identify defects and patient safety hazards; (3) partner senior executive with a unit; (4) learn from defects; and (5) implement teamwork and communication tools (AHRQ, 2011).

The seminal study by Pronovost et al. (2006) was conducted with a focus on reducing CLABSIs and improving the safety culture in 108 ICUs within the state of Michigan. The study intervention targeted the use of bundled evidence-based bloodstream infection prevention practices in conjunction with implementation of the CUSP (Pronovost et al., 2006). The study results demonstrated a 66% decrease from baseline in the statewide CLASBI rates with continued sustainment at 18 months (Pronovost et al., 2006). Success of this seminal study and others resulted in a national program called On the CUSP: Stop BSI formulated to reduce or eliminate CLABSIs in hospitals nationwide (AHRQ, 2012). More than 1,000 hospitals participated in this program and achieved success in reducing nationwide CLABSI rates by 41% (AHRQ, 2012).

The reduction of CLABSIs through multiple collaborative cohort studies has been attributed to the use of evidence-based prevention bundles and improvement in the healthcare safety culture. The CUSP framework has been validated as an essential factor in the success of CLABSI reduction efforts. Continued progress in the reduction of CLABSIs emphasizes the preventability of these infections and will accelerate progress toward elimination.

The purpose of this project was to reduce or eliminate CLABSIs in the ICUS within our national investor-owned 49 hospital healthcare system through the implementation of the CUSP framework. The impact of the CUSP was evaluated using a pre-and post-implementation comparison of hospital CLABSI rates. Data was reported for 65 ICUs, representing 41 hospitals across the baseline pre-and post-CUSP implementation time periods. The total number of CLABSIs reported for the baseline pre-CUSP implementation time period of September 2012 to January 2013 was 71, with an infection rate of 1.10 per 1,000 catheter days. The data for the post-CUSP implementation time period of August 2013 to December 2013 revealed a decrease in the total number of CLABSIs to 42, and a resultant decrease in the infection rate to 0.73 per 1,000 catheter days. This decrease represented a 32.8% reduction in CLASBIs post-CUSP implementation. The evaluation of the CUSP implementation success through the reduction or elimination of CLABSIs validated the potential replication of a systematic approach to address additional quality improvement (QI) initiatives throughout our healthcare system.


CLABSIs; CUSP; Bloodborne infections; Disinfection and disinfectants—Standards; Health facilities—Disinfection; Infection; Infection--Prevention


Bacterial Infections and Mycoses | Community Health and Preventive Medicine | Nursing | Virus Diseases