TY - JOUR
T1 - A quality improvement intervention to reduce indwelling tunneled pleural catheter infection rates
AU - Gilbert, Christopher R.
AU - Lee, Hans J.
AU - Akulian, Jason A.
AU - Hayes, Margaret
AU - Ortiz, Ricardo
AU - Hashemi, David
AU - Thompson, Richard E.
AU - Arias, Sixto
AU - Feller-Kopman, David J.
AU - Yarmus, Lonny B.
N1 - Publisher Copyright:
Copyright © 2015 by the American Thoracic Society.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Rationale: The indwelling tunneled pleural catheter has altered the management of patients with dyspnea related to malignant pleural effusions. However, indwelling tunneled pleural catheter placement does not remain free from risk. The most commonly reported risk is infection. Objectives: The aim of this paper is to describe our continuous quality improvement program for infection rate recognition, the process changes implemented for improvement, and subsequent outcomes. Methods: All patients undergoing indwelling tunneled pleural catheter placement at The Johns Hopkins Medical Institutions between May 2009 and April 2014 were identified. The primary outcome was the incidence of infection within the preintervention and intervention cohorts. Intervention was identified as use of preoperative antibiotics, full sterile draping, and limiting placement to a single defined location. Measurements and Main Results: A total of 225 indwelling tunneled pleural catheter placements were performed in 201 patients during the study period, and the overall infection rate was 5.8%. During the preintervention period, 134 placements were performed, and 91 placements occurred during the intervention period. A preintervention infection rate was identified as 8.2%, with a significant decrease to 2.2% (P = 0.049)within the intervention cohort. Conclusions: The use of a continuous quality improvement program to review indwelling tunneled pleural catheter practices can result in the identification of infectious complications and lead to implementation of measures to improve patient outcomes.
AB - Rationale: The indwelling tunneled pleural catheter has altered the management of patients with dyspnea related to malignant pleural effusions. However, indwelling tunneled pleural catheter placement does not remain free from risk. The most commonly reported risk is infection. Objectives: The aim of this paper is to describe our continuous quality improvement program for infection rate recognition, the process changes implemented for improvement, and subsequent outcomes. Methods: All patients undergoing indwelling tunneled pleural catheter placement at The Johns Hopkins Medical Institutions between May 2009 and April 2014 were identified. The primary outcome was the incidence of infection within the preintervention and intervention cohorts. Intervention was identified as use of preoperative antibiotics, full sterile draping, and limiting placement to a single defined location. Measurements and Main Results: A total of 225 indwelling tunneled pleural catheter placements were performed in 201 patients during the study period, and the overall infection rate was 5.8%. During the preintervention period, 134 placements were performed, and 91 placements occurred during the intervention period. A preintervention infection rate was identified as 8.2%, with a significant decrease to 2.2% (P = 0.049)within the intervention cohort. Conclusions: The use of a continuous quality improvement program to review indwelling tunneled pleural catheter practices can result in the identification of infectious complications and lead to implementation of measures to improve patient outcomes.
KW - Indwelling tunneled pleural catheter
KW - Pleural infection
KW - Systems improvement
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U2 - 10.1513/AnnalsATS.201411-511OC
DO - 10.1513/AnnalsATS.201411-511OC
M3 - Article
C2 - 25871702
AN - SCOPUS:84942251769
SN - 2329-6933
VL - 12
SP - 847
EP - 853
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 6
ER -