Wednesday, April 8, 2009

Penn Medicine Reducing CLABSIs

Central Line-associated bloodstream infections (CLABSI) fell by more than 90 percent in the past three years at the Hospital of the University of Pennsylvania. This is due to a multi-pronged approach combining leadership initiatives, electronic infection surveillance, and checklists to guide line insertion and maintenance.

“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 to be as high as 30 percent, said Neil Fishman, M.D Director of Healthcare Epidemiology and Infection Prevention and Control at the hospital and President Elect of the Society for Healthcare Epidemiology of America.

Previous studies on CLABSI reduction efforts have focused only on intensive care units, but since the majority of cases occur on other hospital floors that care for acutely ill, high-risk patients who require long-term venous access for the delivery of IV medications or nutrition, the Penn researchers wanted to identify ways to eliminate all preventable infections of this kind.

When the campaign began in 2005, more than 30 patients developed CLABSI each month at the hospital. Over time, a series of process, technology, and equipment improvements have cut the number of infections to less than five each month and now only one case was reported in February 2009.

The UPHS has advanced strict adherence to hand hygiene, sterile techniques used during line insertion, and checklists are used. An electronic surveillance program TheraDoc® at a cost of more than one million has been put in place and helps to quash infections. The system enables hospital unit leadership teams to monitor hospital-acquired infection data in real-time, identify problems and trends, and then intervene.

Dr Fishman notes that the hospital system has used this model to attack other hospital-acquired infections such as ventilator-associated pneumonias and catheter-associated urinary tract infections.

In addition, several hospital units have implemented the Toyota Production System which uses processes honed in the auto manufacturing industry to apply to hospitals to reduce variations in practice and to improve hospital care.