ICUs in Michigan Sustain Zero Blood Stream Infections for Up to 2 Years

Intensive care units (ICUs) in both large and small hospitals stopped central line-associated bloodstream infections for up to 2 years after using a targeted quality improvement initiative funded in part by the Agency for Healthcare Research and Quality (AHRQ). The initiative, known as the Comprehensive Unit-based Safety Program, or CUSP, was implemented through the Keystone Intensive Care Unit Project in Michigan hospitals.

The study, "The Ability of Intensive Care Units to Maintain Zero Central Line-Associated Bloodstream Infections" published in today's issue of the Archives of Internal Medicine found that hospital ICUs eliminated central line-associated bloodstream infections (CLABSIs) for an extended period of time-up to 2 years or more. The researchers found that 60 percent of the 80 ICUs evaluated went 1 year or more without an infection, and 26 percent achieved 2 years or more. Smaller hospitals sustained zero infections longer than larger hospitals, the researchers found.

"Previous research has shown that using CUSP to reduce healthcare-associated infections works," said AHRQ Director Carolyn M. Clancy, M.D. "This study gives us even better news-that results from efforts to eliminate these deadly and costly infections can be sustained."

A CLABSI is a serious healthcare-associated infection (HAI) that is introduced into the bloodstream through a central line. According to the Centers for Disease Control and Prevention (CDC), at any one point in time one in every 20 hospital patients in the United States has an HAI.

"This study demonstrates that any hospital ICU can go a year or two without an infection if it commits to implementing this targeted quality improvement initiative. With CUSP, the goal of a year or two without a CLABSI is achievable," said the study's lead author, Peter J. Pronovost, M.D., Ph.D., a professor of anesthesiology and critical care medicine at The Johns Hopkins University School of Medicine in Baltimore. In conjunction with the Michigan Health and Hospital Association, Dr. Pronovost led development of the AHRQ-sponsored Keystone Intensive Care Unit Project to reduce infections in Michigan hospitals by implementing CUSP.

The Keystone Project used a comprehensive approach that included promoting a culture of patient safety; improving communication among ICU staff teams; and using a checklist to promote implementation of practices based on guidelines from the CDC. AHRQ continues to support the nationwide implementation of CUSP through a contract with the Health Research & Educational Trust, an affiliate of the American Hospital Association, by reaching more hospitals and other settings in addition to ICUs and applying the approach to various HAIs. For AHRQ's recently funded HAI projects, go to For more information on CUSP, go to

The CUSP implementation activities support the Partnership for Patients, a new national public-private partnership with hospitals, medical groups, consumer groups and employers that will help save lives by preventing millions of injuries and complications in patient care over the next 3 years. HHS has set a goal of decreasing preventable hospital-acquired conditions by 40 percent (compared with 2010 rates) by the end of 2013. Achieving this goal should result in approximately 1.8 million fewer injuries and illnesses to patients, with more than 60,000 lives saved over the next 3 years. By preventing injuries and complications and reducing readmissions, the Partnership for Patients has the potential to save up to $35 billion in health care costs by the end of 2013.

For additional information, visit the Partnership for Patients at and the HHS Action Plan to Prevent Healthcare-Associated Infections at

Editor's Note: Additional research findings from the Keystone Project are available. One study, "Impact of a Statewide Intensive Care Unit Quality Improvement Initiative on Hospital Mortality and Length of Stay: Retrospective Comparative Analysis," published in the Feb. 1, 2011, issue of the British Medical Journal showed that patients in ICUs participating in Keystone were less likely to die. In "Rates of Pneumonia Dramatically Reduced in Patients on Ventilators in Michigan Intensive Care Units," published in the Feb. 17, 2011, issue of Infection Control and Hospital Epidemiology, researchers demonstrated that hospitals participating in the Keystone project reduced the rate of ventilator-associated pneumonia by more than 70 percent.

For more information, please contact AHRQ Public Affairs: (301) 427-1864 or (301) 427-1539.