Reducing Central Line-associated Blood Stream Infections (CLABSI) and Improving Safety Culture by Implementing the Comprehensive Unit-Based Safety Program (CUSP) in 2 SYSU ICUs in China

Lilly Engineer, MBBS, DrPH, MHA


Millions of patients worldwide suffer unintended harm annually due to unsafe medical care. The World Health Organization estimates the risk to be higher for patients in the developing world. Preventable healthcare-associated infections (HAIs) contribute significantly to this burden. An estimated 1.4 million people have HAIs at any given time with an increased incidence of between 2 and 25 in developing countries like China. In Intensive Care Units (ICUs) the risk for HAIs is even higher, especially central line-associated blood stream infections (CLABSIs). CLABSIs can be prevented by implementing a successful intervention known as the Comprehensive Unit-Based Program (CUSP) and a CLABSI reduction bundle.

The aims of this study is to measurably improve CLABSI rates, length of stay, and safety culture in 2 ICUs in Sun Yat-sen Univeristy, China by implementing the CUSP and to identify locally adaptable variations. This prospective cohort study will evaluate the use of CUSP and the CLABSI prevention bundle in the 2 Chinese ICUs. Safety culture and CLABSI rates will be assessed using standardized instruments and definitions.

Few safety improvement interventions have been tested in the developing world despite the magnitude of the patient safety problem. There is an urgent need to implement successful evidence-based interventions to reduce preventable harm in developing countries like China. The study results will provide: a better understanding of how simple, non-technological interventions can be applied in resource-constrained environments to provide safer care, and with suitable adaptation, an opportunity to eventually scale up the proven CUSP/CLABSI intervention to all ICUs within China and worldwide.