Drop in Infections at UPenn Hospital a Multi-faceted Task

March 31, 2009

Physicians at UPenn are attributing the 90% drop in central line-associated bloodstream infections seen over three years to a "multi-pronged approach" that included "leadership initiatives, electronic infection surveillance, checklists to guide line insertion and maintenance, and implementation of the Toyota Production System to encourage best practices in line care."

Physicians at the University of Pennsylvania (UPenn) are attributing the 90% drop in central line-associated bloodstream infections seen over three years (CLABSI) to a “multi-pronged approach” that included “leadership initiatives, electronic infection surveillance, checklists to guide line insertion and maintenance, and implementation of the Toyota Production System to encourage best practices in line care.” Those involved in the study said their findings—presented last week at the 19th Annual Meeting of the Society for Healthcare Epidemiology of America—“provide a road map for cutting the deadly, costly toll of hospital-acquired infections nationwide.”

Previously conducted studies on CLABSI have focused on intensive care units (ICUs). However, because most of these infections occur on other units where care is provided for acutely ill patients requiring central lines for nutrition and medication, according to the researchers, the aim was to try and eliminate all of these various kinds of infections that are avoidable.

The staff at the UPenn hospital utilized different techniques to drive the number of CLABSI down. Early aspects of the initiative included “strict adherence to hand hygiene, chlorhexidine to clean the skin prior to procedures, and sterile techniques during line insertion, access and dressing changes.”

Addressing the issue of poorly placed dressings over the line sites and the use of new technology to improve “the management of catheter insertion sites” also cut down on the number of infections seen by the staff. Also, TheraDoc, an electronic monitoring system, enabled the UPenn physicians to observe the incidences of CLABSI in real time and then control or stop them. Further, an observation by staff members that a cap put inside the lines to prevent clotting was causing a higher rate of infections led to the discontinuation of the caps, which further declined the number of infections.

“We were only able to see a sustained reduction in infections when we took a multifaceted approach throughout the entire hospital,” said Neil Fishman, MD, director of Healthcare Epidemiology and Infection Prevention and Control, UPenn Hopsital. “There are many procedures, many steps and many personnel that are involved in the placement, care and maintenance of central venous catheters. We have learned that a successful program to reduce CLABSI must take all of these factors into consideration. Central line-associated bloodstream infections can add up to $40,000 to the cost of a hospitalization and take their toll in human lives. The mortality rate of CLABSI has been reported as high as 30 percent. Our program ultimately makes the hospital a safer place to receive medical care.”