As a result of the landmark Keystone ICU project, central line–associated bloodstream infections (CLABSIs) have emerged as a flagship patient safety target in recent years. The national Comprehensive Unit-Based Safety Program (CUSP) initiative aims to further disseminate these results by creating state-level cohort collaboratives. This current report of the initiative's implementation and sustainability in Hawaii continues the project's encouraging results, with CLABSI rates significantly decreased across the entire state. Most notably, Hawaii has successfully spread this program beyond adult intensive care units (ICUs) into pediatric and neonatal ICUs, and even non-ICU wards. The article outlines specific innovative tools and strategies utilized by the Hawaii collaborative, with an emphasis on cultural change and establishing new local norms. An AHRQ-sponsored CUSP toolkit is freely available.