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National - International initiatives

Comprehensive Unit-based Safety Program (CUSP) and HAI

CUSP and AHRQ- Health care-associated infections resource

Vital Signs

New data from the Centers for Disease and Control and Prevention (CDC) show that 58 percent fewer bloodstream infections occurred in hospital ICU patients with central lines in 2009 than in 2001. In 2009, about 18,000 bloodstream infections occurred in ICU patients with central lines. About 23,000 more happened to patients who got treatment in other areas of the hospital.

Much of this progress can be attributed to the national, regional, state and hospital initiatives described on this website.

IHI 100,000 Lives Campaign

The Institute for Healthcare Improvement (IHI) 100,000 Lives Campaign is an initiative to engage U.S. hospitals in a commitment to implement changes shown to improve patient care and prevent avoidable deaths. The campaign, launched in January 2005, is the first national effort to promote saving a specified number of lives by a certain date (June 14, 2006). The goal was actually exceeded (122,342 lives) by the deadline and IHI plans to intensify and expand the campaign during remainder of 2006. As of May 2006, there were more than 3,000 hospitals in all 50 states and Washington, DC that submitted data to the IHI 100,000 Lives Campaign. IHI's Web site offers tools, resource kits, "how-to" guides, discussion groups, and education programs to help hospitals make "major, rapid changes" using best practices. One example of such programs is creation of ventilator and central-line bundles, or groups of interventions that can be co-implemented.

As part of its 100,000 Lives Campaign, IHI advocates the use of six proven, life-saving interventions. When done in concert, these interdependent steps, also called "bundles," typically result in significantly better outcomes than when implemented individually.

IHI's initial six interventions are:

  1. Deploy Rapid Response Teams (RRT) at the first sign of patient decline.
  2. Deliver reliable, evidence-based care for acute myocardial infarction to prevent deaths from heart attack.
  3. Prevent adverse drug events (ADEs) by implementing medication reconciliation.
  4. Prevent central line infections by implementing a series of interdependent, scientifically grounded steps called the "Central Line Bundle."
  5. Prevent surgical site infections (SSI) by reliably delivering the correct perioperative care.
  6. Prevent ventilator-associated pneumonia by implementing a series of interdependent, scientifically grounded steps called the "Ventilator Bundle."

IHI provides a "Getting Started Kit" for each intervention. Each kit contains three documents:

  1. A "How-to Guide" with instructions for implementing the change in your organization, including changes and measures.
  2. A slide presentation with facilitator notes to introduce and explain the intervention in your organization.
  3. An annotated bibliography.

For more information, visit the IHI Web site:
http://www.ihi.org/IHI/Programs/Campaign/

Examples of bundles

Eliminating (VAP)-associated pneumonia and catheter-related bloodstream infections is the focus of two of the six interventions that have been widely implemented with great success. The campaign includes a series of steps to reduce or prevent VAP and catheter-related bloodstream infections (CR BSI).

IHI Central Line Bundle

The five key components of the Central Line Bundle are:

  1. Hand hygiene. (A new "how to" tool for hand hygiene
    is available.)
  2. Maximal barrier precautions.
  3. Chlorhexidine skin antisepsis.
  4. Optimal catheter site selection, with subclavian vein as the preferred site for non-tunneled catheters.
  5. Daily review of line necessity, with prompt removal of unnecessary lines.

Additional central line resource

IHI Ventilator Bundle

Four key components of the Ventilator Bundle are:

  1. Elevation of the head of the bed to between 30 and 45 degrees.
  2. Daily "sedation vacation" and daily assessment of readiness to extubate.
  3. Peptic ulcer disease (PUD) prophylaxis.
  4. Deep venous thrombosis (DVT) prophylaxis (unless contraindicated).

Additional ventilator resources

Additional pneumonia resources

Premier Perinatal Safety Initiative

Currently there are three birth related injuries per 1,000 deliveries and the United States ranks near the bottom of industrialized nations in infant mortality. The Premier healthcare alliance launched a 21-month national collaborative designed to achieve consistent delivery of evidence-based care with the goal of eliminating preventable birth related injuries and deaths. The first collaborative group was comprised of 16 of the country's leading hospitals of varying sizes and locations, representing 12 states, at which approximately 115,000 babies will be delivered over the course of the collaborative. Leveraging knowledge gained from similar initiatives, including a Premier/Ascension Health/Institute for Healthcare Improvement collaboration, the participating hospitals aimed to improve their culture of safety, increase teamwork and improve communications among team members.

The initiative seeks to significantly lower the incidence of certain infrequent though serious injuries that could result in birth asphyxia or permanent neurologic disability. Through the use of “care bundles,” groups of evidence-based interventions that are more effective when implemented together rather than individually, participants work toward the elimination of perinatal injuries. These bundles, which follow national standards established by expert clinical organizations, such as the American College of Obstetricians and Gynecologists (ACOG) and the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), are scored in an “all-or-none” fashion.

One of the collaborative participants, Kettering Medical Center, Dayton OH, reported a 30 percent reduction in the rate of elective inductions at less than 39 weeks gestation and more than 50 percent 50 percent reduction in special care nursery admissions.

Premier has announced plans to launch their second Perinatal Safety Initiative in September 2009.

Safer Healthcare Now! Canadian Collaborative

In April 2005, the Safer Healthcare Now! (SHN) Campaign was launched. A key component in the advancement of patient safety in Canada, SHN has struck a “chord of caring” across the country, with 151 participant organizations (hospitals and health regions) and 404 clinical teams enrolled in the Campaign in the past year. With its goal to improve healthcare delivery by focusing on patients and their safety while in the care of health providers, SHN is a collaborative effort aimed at reducing the number of injuries and deaths related to adverse events, such as infections and medication incidents.

Similar to its model, the U.S. Institute for Healthcare Improvement's 100,000 Lives campaign,the primary focus of the SHN Campaign is the implementation of six targeted interventions to improve patient care. The 404 teams involved in the Campaign are committed to implementing one or more of the interventions in their healthcare settings. While these interventions focus on the acute care sector, it is anticipated that the Campaign will expand to include participants from a variety of healthcare areas.

Veterans' Affairs – GAPS

The Veteran's Affairs' "Getting at Patient Safety" (GAPS) Center is a unique partnership of clinicians, administrators, and experts in human performance funded to improve patient safety in healthcare. Its focus is on how gaps in continuity of care are bridged by practitioners, and its goal is to create the components of a "safety culture." This includes creating tools to support technical work in healthcare, fostering understanding of predictable human performance failure and its impact in safety within and beyond the Veterans Affairs Health Administration, and creating tools to move healthcare organizations toward a safety culture.

Additional resources

Veterans' Affairs National Center for Patient Safety (NCPS)

NCPS was established in 1999 to develop and nurture a culture of safety throughout the Veterans Health Administration, with the goal of reducing and preventing inadvertent harm to patients as a result of their care. Patient safety managers at 157 VA hospitals and patient safety officers at 21 VA regional headquarters participate in the program. Additional information on hand hygiene and other interventions to reduce healthcare-associated infections (HAI) is available.