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Using Collaboratives to Reduce CLABSI (Text Version)

Slide presentation from the AHRQ 2009 conference.

On September 15, 2009, John R. Combes, MD, and Peter Pronovost, MD made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (3,182 KB)

Slide 1

Using Collaboratives to Reduce Central Line-Associated Bloodstream Infections (CLABSI): A National Implementation Program

Peter Pronovost, MD
John R. Combes, MD

Slide 2


  • Context and National Leadership
  • State Level Consortia
  • Sustainability
  • Q&A 

Slide 3

National Context and Leadership

Slide 4

HHS Steering Committee for the Prevention of HAI

  • Charge: Develop an Action Plan to reduce, prevent, and ultimately eliminate HAIs
  • Plan will:
    • Establish national goals for reducing HAIs
    • Include short- and long-term benchmarks
    • Outline opportunities for collaboration with external stakeholders
    • Coordinate and leverage HHS resources to accelerate and maximize impact 

Slide 5

Steering Committee
Working Group Structure

Image of an organization chart. The HHS Steering Committee for the Prevention of HAI is the top division and the working groups are shown below.

  • Prevention and Implementation - Lead: CDC
  • Research l - Lead AHRQ
  • Information Systems and Technology - Co-Leads: OS/ONC & CDC
  • Incentives and Oversight - Co-Leads: CMS
  • Outreach and Messaging - Lead: OS / OPHS 

Slide 6

HHS Action Plan

Slide 7

Tier One Priorities

HAI Priority Areas

    • Catheter-Associated Urinary Tract Infection
    • Central Line-Associated Blood Stream Infection
    • Surgical Site Infection
    • Ventilator-Associated Pneumonia
    • MRSA
    • Clostridium difficile

Implementation Focus

    • Hospitals

*Tier Two will address other types of healthcare facilities 

Slide 8

AHA's Hospitals in Pursuit of Excellence

  • Reduce Surgical Infections and Complications
  • Reduce Central Line-associated Blood Stream Infections (CLABSI)
  • Reduce methicillin-resistant Staphylococcus aureus (MRSA)
  • Reduce clostridium difficile infections (c diff)
  • Reduce ventilator-associated pneumonia (VAP)
  • Reduce catheter-associated urinary tract infections
  • Reduce adverse drug events from high-hazard medications (e.g., anticoagulants, narcotics, opiates, insulin, sedatives)
  • Reduce pressure ulcers 

Slide 9

State Consortia 

Slide 10

Project Organization

  • Statewide effort coordinated by State Hospital Association including QIOs and State DOHs
  • Collaborative model
  • Standardized data collection tools and evidence
  • Local ICU modification of implementing interventions
  • Implementing interventions outside the ICU 

Slide 11

Participating States

  • 10 states with at least 10 hospitals in 2008-2011
    • California
    • Colorado
    • Florida
    • Massachusetts
    • Nebraska
    • North Carolina
    • Ohio
    • Pennsylvania
    • Texas
    • Washington 

Slide 12

CUSP Expansion

  • All hospitals within the states are eligible
  • The following states are in the expansion:
    • Alabama, Alaska, Arizona, Delaware, District of Columbia, Idaho, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Montana, Nevada, North Dakota, Puerto Rico, South Dakota, Utah, Vermont, Virginia, Wyoming 

Slide 13

JHU Funded State Projects

  • Arkansas Hospital Association
  • Connecticut Hospital Association
  • Georgia Hospital Association
  • Healthcare Association of Hawaii
  • Illinois Hospital Association
  • Indiana Hospital Association
  • Minnesota Hospital Association
  • Missouri Hospital Association
  • New Hampshire Hospital Association
  • New Jersey Hospital Association
  • New Mexico Hospital Association
  • Healthcare Association of New York State
  • Oklahoma Hospital Association
  • Oregon Hospital Association
  • South Carolina Hospital Association
  • Tennessee Hospital Association
  • West Virginia Hospital Association
  • Wisconsin Hospital Association 

Slide 14

State Consortia Members

  • State hospital associations
  • QIOs
  • State health departments

May include

  • Payers
  • PSOs
  • Government officials
  • Business 

Slide 15

State Hospital Associations

  • Serve as project coordinator for state consortia and participating hospitals
  • Facilitate conference calls and in-person meetings with HRET/JHU/MHA faculty
  • Oversee collection of CLABSI and safety culture data 

Slide 16

Role of QIOs

  • Part of state infrastructure-lend expertise and other resources to support initiative
  • Participate in conference calls, in-person meetings 

Slide 17

Building State Programs to Prevent HAIs

  • Project Description:
    • Create and expand state-based HAI prevention collaboratives
    • Build a public health HAI workforce in states
    • Enhance states abilities to assess where HAIs are occurring
  • Agency Lead: CDC
  • Collaborating Agencies: AHRQ and CMS
  • Funds Source & Amount: ARRA ($40 M)
  • CDC HAI Recovery Act Website

Slide 18

Consortia Organization

  • Lead Partner Role: State Hospital Association or affiliated state hospital association organization coordinating the state-wide collaborative.
  • Advisor role: will support the collaborative effort with infectious disease expertise.
  • Endorser role: will support the collaborative by promoting On the CUSP: Stop BSI and by providing cash or in-kind resources such as meeting space.

 Slide 19

NC Safer ICUs: Eliminating CLABSI Collaborative

Organization Name Organization Website Designation of Organization Key Contact
Name / Title
Key Contact Telephone Key Contact Email Collaborative Role
Duke Infection Control Outreach Network (DICON) DICON is a private membership organization, established in 1997 by Duke physicians and nurses, that exists to advance efforts that improve quality of care and enhance patient safety while minimizing the costs associated with non-evidence based approaches to infection control. Deverick Anderson, MD, MPH Assistant Professor Medicine 919-681-7483 Advisor Role
Will support the collaborative effort with infectious disease expertise to provide guidance to the leadership team and collaborative hospitals.
North Carolina Area Health Education Centers Program (AHEC) NC AHEC's mission is to meet the state's health and health workforce needs by providing educational programs in partnership with academic institutions, health care agencies, and other organizations committed to improving the health of the people of North Carolina. Rebecca Knight, MSN, MBA Executive Director 336-832-7933 Endorser Role
Will support the Collaborative by helping to spread the word and to support it meetings with venue (classroom) space as available.
The Carolinas Center for Medical Excellence (CCME) The designated Quality Improvement Organization (QIO) for NC. Holds the federal and state contracts for Quality Improvement under CMS in NC. Jill McArdle, RN, MSPH, CPHQ, PMP Director Federal Programs 919-380-9860 Endorser Role
Will support the Collaborative by helping to spread the word and will look at alignment with initiatives.
NC Center for Hospital Quality and Patient Safety (NC Quality Center) Created in 2004, the NC Quality Center, an initiative of the NC Hospital Association, funded by grants and donations, mission is to lead NC hospitals to become the safest and highest quality hospitals in the United States. In addition the NC Quality Center is the federally designated Patient Safety Organization (PSO) for NC. Barb Edson, RN, MBA, MHA Director of Collaborative Learning 919-677-4121 Lead Partner Role
Lead role for NC Consortia Liaison between other NC organizations and National group. Liaison between NC hospitals and NC and national consortia.

Slide 20

Florida Consortium

Organization Name Organization Website Designation of Organization Key Contact
Name / Title
Key Contact Telephone Key Contact Email

Collaborative Role* (you may use your own descriptions or use the ones listed below)


Florida Hospital Association State hospital association Kim Streit/VP/Health care Research and Information 407-841-6230 Lead Partner Role
Florida Professionals in Infection Control Professional Association for Florida’s Infection Control practitioners Loretta Litz Fauerbach 352-265-0284 Advisor Role
Florida Medical Quality Assurance Inc. Quality improvement organization Marie Hall 813-865-3538 Advisor Role
BlueCross BlueShield of Florida One of Florida’s Largest Health Plans Brian Kiss, MD 813-865-3538 Endorser Role
Department of Health Staff agency responsible for tracking infections Roger Sanderson Advisor Role
PSOFlorida   Staff agency responsible for tracking infections Bill Bell, FHA General Counsel



Advisor Role


Slide 21

Evolving Consortia Roles

  • SHA
    • Recruitment, Marketing, Convening
  • QIO
    • Training, Field Agent
  • DOH
    • Technical Support, Analysis, Epidemiology 

Slide 22


Slide 23

State Consortia & Sustainability

  • State consortia key to sustainability:
    • Train-the-trainer education to build capacity for future patient safety innovations, e.g., On the CUSP: Decubiti
    • Evaluation component to identify lessons, including critical success factors and barriers 

Slide 24


A model for the development of resource materials to support instructor-delivered in service training and faculty development


  1. Instructors/Leader's Guide
  2. Camera ready materials for handouts
  3. Presentation materials (PowerPoint slides & videos)
  4. Evaluation instruments

Battles JB, Sheridan MM The FLEXTRA Kit: a model for instructor support materials. J Biocommunication; 1989:6;3;1-13.6 

Slide 25


  • Begins with all existing content as well as new content developed as part of the project
  • Identifies key concepts to be illustrated through video vignettes
  • Work with experts in CUSP, care in each selected hospital unit, and adult learning to develop storyboards and final scripts for the vignettes
  • The compilation of the video vignettes supervised by clinical experts
  • The embedding of the video content into DVD and CD format suitable for bundling with other training materials
  • The development and editing of the instructional guides, in collaboration with experts in both CUSP and adult learning concepts
  • The final bundling of all the resources into print and electronic formats that are:
    • Fully in the public domain
    • 508 compliant
    • Branded as an AHRQ product, but designed to be co-branded 

Slide 26

Image of a charge

  1. Core team prepares State Coordinators to implement CUSP-CLABSI using a Professional Development Workshop that
    1. Familiarizes them with the project and the materials;
    2. Teaches them how to teach using these materials; and
    3. Teaches them how to facilitate others in implementing CUSP-CLABSI
  2. State Coordinators / core team prep are hospital teams of representatives to implement CUSP-CLABSI using a Train the Trainer method that
    1. Familiarizes them with the project and the materials;
    2. Teaches them how to teach using these materials; and
    3. Teaches them how to facilitate others in implementing CUSP-CLABSI
  3. Hospital representatives work with QI staff at their hospitals to implement CUSP-CLABSI, blanketing all relevant hospital staff in the relevant training and rolling out CUSP-CLABSI State Coordinators / core team provid follow up coaching calls to hospital representatives.

Emanuel, L (2009) 

Slide 27


Slide 28

HAI Elimination Collaboration

Policy Leadership

Field Leadership

Implementation Leadership

Slide 29


  • National Commitment
  • Strong Collaboration
    • Federal Agencies
    • Provider Organizations
    • State Stakeholders
  • Local Consortia Sustainability
    • Unit Based Culturally Driven Improvements 

Slide 30


Current as of December 2009
Internet Citation: Using Collaboratives to Reduce CLABSI (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD.


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