More than 350 U.S. hospitals participating in On the CUSP: Stop BSI have reduced rates for central line-associated bloodstream infections in adult intensive care units by 35 percent. Hospital data come from the first 22 states participating in the national initiative. Many of the participating hospital ICUs had CLABSI rates below the national mean at baseline and still were able to reduce their rates.

This national progress in reducing CLABSIs is the sum of individual hospital successes, and trustees have played an important part. Trustees are responsible for creating a culture of quality and reliability within their organizations, from equipping hospital staff with the right tools to holding staff and providers accountable for improving care.

On the CUSP: Stop BSI provides a set of strategies and tools that marry evidence-based, infection-prevention practices—technical quality—and the adaptive approach of the Comprehensive Unit-based Safety Program's teamwork and communication tools to improve patient safety. The initiative is led by the Health Research & Educational Trust, the Johns Hopkins University Quality and Safety Research Group, and the Michigan Health & Hospital Association's Keystone Center for Patient Safety & Quality, and funded by the Agency for Healthcare Research and Quality.

The Board's Role

The project's technical component challenges hospitals to reduce CLABSIs to 1 per 1,000 catheter days using five key evidence-based clinical interventions and a central-line checklist. To drive home the importance of the technical component for CLABSI elimination, hospital trustees should:

  • Commit to a goal of zero CLABSIs
  • Provide resources to staff in accordance with evidence-based practices
  • Monitor CLABSI data at least quarterly
  • Treat each CLABSI as a sentinel event and require staff to investigate every occurrence

Technical improvements only can be sustained if hospitals and their boards commit to supporting a culture of safety. Trustees of successful hospitals support the adaptive work of CUSP to improve teamwork and communication by:

  • Reviewing safety-culture survey findings annually and monitoring results of unit action plans developed to address identified improvement opportunities
  • Holding senior leaders accountable for engaging with unit patient-safety efforts
  • Holding unit-level leaders accountable for any infections that occur, and taking corrective actions with nurses and physicians as needed
  • Supporting the empowerment of nurses to stop senior physicians from inserting lines when protocols aren't followed
  • Bringing patient stories into the boardroom by hearing one story of harm from infection at each board meeting

Using the CUSP/CLABSI framework, hospital boards can measure unit-based progress toward eliminating CLABSIs and improving safety culture. Boards must review not only rates, but also the actual number of CLABSIs to monitor and investigate each occurrence, further supporting a culture of learning when things go wrong. This level of collaboration allows the board to monitor as well as enable progress through adequate resource allocation.

Looking Forward

The lessons to date from the CUSP/CLABSI initiative demonstrate the important role trustees play in attending to both the technical and adaptive components of quality in their hospitals. Such quality oversight can lead to operational changes that eliminate CLABSIs, saving lives and money while improving the safety culture in America's hospitals.

For more information about CUSP, including a board checklist, visit To read the AHRQ progress report on the initiative, go to

Marchelle Djordjevic ( is a senior project manager, HRET.