Improvement Stories

Preventing Central Line Infections: Saving Lives and Dollars

Why is preventing central line infections important to safe patient care?

Each year across the United States, 5-7 million central venous catheters, also known as “central lines,” are inserted into patients to deliver vital, and often life-saving, medicines and fluids. Nearly half of all Intensive Care Unit (ICU) patients receive a central line during their hospital stay. While these devices are an essential part of a patient’s care plan, they can cause blood stream infections if proper insertion and maintenance techniques are not followed. It is estimated that nearly 250,000 central line infections occur in the United States each year, with nearly 80,000 of those in ICU settings. These infections lengthen hospital stays, increase costs, and can even lead to death. Thankfully, there are evidence-based procedures that clinicians can take to reduce a patient's risk of infection.

What is MGH doing to reduce central line blood stream infections?

Central Line KitRecent evidence suggests that reducing central-line blood stream infections is achievable if certain clinical practices are consistently applied. For central line insertions, some of these practices include using proper hand hygiene techniques, applying a chemical called chlorhexidine at site of insertion, and using “sterile barriers”, such as full body drapes for patients and gloves and gowns for clinicians. Steps must also be taken to properly maintain inserted lines, such as frequently cleaning the insertion site, changing the dressings around it, and assessing whether lines are suitable to be removed.

MGH used a process improvement technique known as “rapid prototyping” to operationalize these practices in all ICUs. Each unit started the week using the same tools and procedures for central line insertions, which included a standard kit or cart, handoff procedure, list of appropriate maintenance practices, checklist for sterile technique observations, and a feedback and learning tool. Staff were allowed to modify elements to fit their needs over the course of the week. Unit representatives met after to debrief the prior week's experience and develop one standard by which to apply on their next line insertion. In this way, practices converged and diverged until consensus was reached across all participating units. 

How are we doing?

Following the implementation of these practices, the central line infection rates decreased in each ICU. Several areas have reported one or more quarters with zero infections. MGH is continues to roll out these best practices hospital-wide and work hard eliminate infections.

 

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