Hospital Infection Control

Buried in a relatively mundane update of the nationwide success in preventing central line associated bloodstream infections (CLABSIs), there is an implicit bombshell of a question for infection preventionists: Does the CUSP (Comprehensive Unit-Based Safety Program) strategy widely advocated by the Agency for Healthcare Research and Quality (AHRQ) threaten your program? Do you feel, dare we ask, a sense of resistance or liberation?

Consider this excerpt from an AHRQ interview with two senior officials at the agency: Stephen Hines, PhD, Vice-President for Research at the Health Research and Educational Trust (HRET) and a senior adviser on the CUSP-CLABSI and CUSP CAUTI projects; and James Battles, PhD, Senior Service Fellow for Patient Safety at the AHRQ Center for Quality Improvement and Patient Safety (CQulPS).

Tell me about the disruptive nature of QI and CUSP. How does one overcome resistance from those being disrupted?

Dr. Battles: CUSP has been a disrupting force within the infection control community, which initially felt threatened as the locus of control moved from an external watchdog agency (CDC) to the unit itself, and as the focus shifted from measurement to QI. This disruption has been felt inside individual hospitals and at the national level, as existing power structures become threatened.

Dr. Hines: To overcome resistance, one must understand and try to accommodate the interests of those whose work activities may be disrupted. CUSP shifts the traditional responsibility for monitoring infection rates away from clinicians focused on infection prevention to the entire care team. That could be threatening, but it also could be very liberating. Rather than feeling bogged down in data collection, monitoring, and reporting, the infection prevention professional can work with the CUSP team to focus on what they have been trained and are uniquely qualified to do, preventing infections.

With the CUSP-CAUTI (catheter-associated urinary tract infection) project, we’re working with relevant professional associations to develop an integrated, multidisciplinary program to equip infection preventionists, nurse executives, unit managers, hospitalists, and others involved in infection control to collaborate effectively to prevent infections. Understanding each other’s roles, responsibilities, and concerns and coordinating their efforts will better enable them to support their peers in participating hospitals. Breaking down silos between different groups of clinicians and treating infection prevention as a shared responsibility is essential to a successful and sustainable infection prevention effort. Development of this program is just getting started, but it’s already clear that there are large benefits to facilitating conversations that enable each group to better understand the perspectives of others.