Henry Ford Hospital's Hematology-Oncology Unit Uses AHRQ Safety Program to Lower Bloodstream Infections

Using AHRQ's Comprehensive Unit-based Safety Program (CUSP), Henry Ford Hospital in Detroit has reduced the incidence of central line-associated bloodstream infections (CLABSIs) in its hematology-oncology unit by 75 percent, documenting only two between July 2020 and June 2021. The reduction not only prevented patient harm, it also saved an estimated $385,000 in healthcare costs that would have been incurred to treat the infections.

CUSP is a method that can help clinical teams make care safer by combining improved teamwork, clinical best practices, and the science of patient safety. The Core CUSP toolkit gives clinical teams the training resources and tools to apply the CUSP method and build their capacity to address patient safety issues.

Most patients on Henry Ford's 40-bed hematology-oncology unit need peripherally inserted central catheter (PICC) lines for chemotherapy, blood transfusions, or intravenous nutrition. In 2019, the unit recorded 16 CLABSIs, eight of which were from PICC lines. This was the highest number since the hospital started tracking infection rates, according to Kelsey Hebel, M.S.N., R.N., the unit's clinical nurse specialist.

As unit staff examined root causes of its CLABSI rates, they found that staff weren't using a standard protocol for pre-insertion of PICC lines. "Everyone on the unit was doing it differently. Everyone was preparing a patient differently," Hebel said. The lack of a standardized process affected patients awaiting a PICC line placement, according to Sharron Alejandria, B.S.N., R.N., a unit educator specializing in interventional radiology.

"We didn't consistently educate our patients about properly maintaining their PICC lines or the importance of their daily baths [with chlorhexidine gluconate] to decrease the potential spread of bacteria," Alejandria said.

Complicating matters, patients weren't routinely informed of the indications for or benefits of the PICC before the PICC team arrived. In addition, the PICC team encountered delays when patients' rooms weren't cleaned beforehand, Alejandria added. "This is a sterile procedure, and the room has to be cleaned before the procedure can begin."

Eager for a solution, unit staff and the PICC team responded positively when surveyed about their willingness to undertake the CUSP protocol training, Hebel said. In 2019, Henry Ford's leadership had assembled a core team of frontline staff and executive leaders who supported the rollout of CUSP in several units, and the unit staff built on that foundation, according to Swati Verma, M.S., the hospital's principal management engineer for performance excellence and quality.

"The infrastructure was in place for teams to quickly add patient safety projects through the CUSP methodology," Verma said.

As they implemented CUSP's teamwork and communication module, the unit's nursing staff realized "we had a lack of understanding of what our workflow looked like and what the PICC team's workflow looked like," Hebel said.

Not only have the teams since learned each other's responsibilities, they've come to rely on each other for education and troubleshooting. For example, the PICC team has developed general education for unit staff to address potential issues before they arise, according to Alejandria. In turn, Hebel said, the unit staff has "no problem saying to the PICC team, 'This isn't working, can you take a look?'"

With the CUSP protocol fully in place, the process by which PICC lines are ordered, placed, and maintained now is clear and consistent. Once an order is put into a patient's chart, the PICC team reviews it and contacts the hematology-oncology unit to schedule an appointment for the patient.

A unit nurse explains the upcoming procedure and the need for a daily chlorhexidine bath to the patient. Those messages are reinforced when the PICC team arrives to perform the procedure, Alejandria said. "This leaves the patient feeling confident that everyone across the disciplines—health provider, nurses, PICC team—has a handle on what's going on."

With CLABSI rates down dramatically in one year, the hematology-oncology unit has its eyes on eliminating CLABSIs completely and sharing their experience with units that use other types of invasive lines. Henry Ford now is expanding the new process to other patient care units.

"Our goal is zero [infections]," said Hebel. "This was kind of a first step. We're continuing to check our data and see great progress with this."