Using real-time problem solving to eliminate central line infections.

Area of Science:

• Healthcare quality improvement
• Patient safety
• Infection control

Background:

• Central line-associated bloodstream infections (CLABs) affect 200,000 Americans annually, with a 15-20% mortality rate.
• Variations in care processes create conditions conducive to CLABs in intensive care units (ICUs).

Purpose of the Study:

• To redesign care processes in ICUs to achieve reliable outcomes and eliminate CLABs.
• To reduce the incidence and mortality associated with central line infections through system improvements.

Main Methods:

• Applied the Toyota Production System principles (Perfecting Patient Care) to central line placement and maintenance in two ICUs.
• Conducted intensive observations and root cause analyses to identify and address process variations.
• Empowered staff to implement countermeasures for defects in central line care.

Main Results:

• Implemented new processes within 90 days, leading to a sustained decrease in CLABs from 10.5 to 1.2 infections/1,000 line-days over 34 months.
• Reduced mortality from CLABs from 51% to 16% within one year.
• Achieved these improvements despite an increase in central line utilization and line-days.

Conclusions:

• CLABs are preventable and result from unreliable, variable care delivery, not inherent complexity of ICU care.
• System redesign and process standardization are effective strategies for eliminating healthcare-associated infections.