Exposure Survey
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1. On the CUSP: Stop BSI - Assessment of Previous Exposure

 
 100% 
Survey to assess previous exposure to elements of the intervention.

Complete one survey per CUSP Unit.
1. What state are you located in?
2. Hospital name and city:
3. How many ICUs are there in this hospital?
4. Type / designation of this unit
5. Number of beds in the CUSP unit:
6. Who may we contact with follow-up questions on the content of these responses (primary respondent)?
7. Contact Title:
8. Contact Phone Number:
9. Which of the following initiatives or programs has your unit participated in to prevent central line infections? Select all that apply.
10. What is your average nurse to patient ratio?
11. Are your central line infection rates regularly (i.e. monthly, quarterly) reported to hospital senior executives?
Please indicate the degree to which each of the following has taken place in your unit by placing a check mark in the button that reflects the experience in your CUSP Unit
12. Do you know your unit's (CUSP) central line infection rate?
13. Participation in any organized multi-state effort to reduce bloodstream infections
14. Having all staff view the Josie King video
15. "Partnership" with unit by Senior Executive for patient safety
16. Systematic analysis and proactive learning from harmful events or events with the potential for harm as raised by front-line staff (other than M & M and offical RCA)
17. Setting daily goals for each patient based on a standard tool
18. Educating staff on the "Science of Safety"
19. Use of an independent line cart or kit, stocked with essentials for placing a central line catheter
20. Inclusion of chlorhexidine in the central line kit
21. Routine use of chlorhexidine for dressing changes
22. Use of a standard protocol for dressing changes
23. Use of a line insertion checklist to ensure compliance with evidence based practices
24. Reporting to the Center for Disease Control's (CDC) National Healthcare Safety Network (NHSN)
25. Any unit-wide assessment of teamwork and safety culture (e.g. Safety Attitude Questionnaire, Hospital Survey on Patient Safety)
26. If yes to question 25, when did you last complete the unit-wide assessment of teamwork and safety culture?
27. If yes to question 25, which survey instrument did you use?
28. If you used the Hospital Survey on Patient Safety, did the version that was used allow for the identification of the unit?
29. Do you have the ability to distribute the survey electronically to your physicians and staff?