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 have a central line during their hospital stay. While central lines are an essential part of a patient’s care, they are associated with blood stream infections if proper techniques and procedures are not followed. Nearly 250,000 central line infections occur in the United States each year, with nearly 80,000 of those in ICU settings. These infections have lead to longer hospital stays, higher costs, and can even lead to death. Thankfully, there are procedures that health care staff can take to reduce the risk of patients acquiring these infections.
Recent evidence suggests that a rate of zero central-line blood stream infection is achievable if certain clinical practices are consistently applied. For central line insertions, some of these practices include using proper hand hygiene technique, rubbing a chemical called chlorhexidine at site of line insertion, and using “sterile barriers,” such as full body drapes for patients, and sterile gloves and gowns for clinicians. Steps must also be taken to properly maintain inserted lines (e.g.—cleaning the insertion site and changing the dressings around it), and assess whether they are suitable to be removed.
To facilitate the implementation of these practices in all MGH ICUs, the MGH used a process improvement technique known as “rapid prototyping”. All units started each week using the same tools and procedures for central line insertions. These tools included a checklist with an observer trained in sterile technique, a standard kit or cart, a handoff procedure, appropriate maintenance practices and a feedback and learning tool.
The units were allowed to modify all elements to fit their needs over the course of the week. At the end of every week unit representatives met to debrief on the prior weeks 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.
Following the implementation of these practices, the central line infection rates decreased in each ICU with several having one or more quarters with zero infections. Hard work remains to minimize or eliminate these infections, and the MGH is continuing to roll out these best practices hospital wide.