Central Line Infection Rates Reduced Through Sustained Quality Improvement Initiative
Results published in The Joint Commission Journal on Quality and Patient Safety
STONY BROOK, N.Y., January 22, 2013 – Stony Brook University Hospital reduced its infection rates associated with central line placements by 59 percent over a five-year period, including by more than 80 percent over the final 12 months of the reported period. The results were published in an article titled “A Multidisciplinary Approach to Reduce Central-Line Associated Bloodstream Infections” in the February 2013 issue of The Joint Commission Journal on Quality and Patient Safety, a peer-reviewed journal published by Joint Commission Resources.
The authors cited a critical feature of the hospital’s initial approach as establishing buy-in and oversight of the hospital’s leadership in the Surgical Intensive Care Unit (SICU) through a multi-disciplinary team, which became the “learning laboratory” for subsequent changes in clinical practice. Other fundamental success factors, the study said, included the “hardwiring” of changes to sustain improvements, and a culture change that shifted staff perceptions of central line infections from “unavoidable complications” to failures.
Seven SBUH staff members and physicians authored the report: Christine McMullan, MPA, CPHQ, Director of Continuous Quality Improvement (CQI); Grace Popper, MS, RN, Quality Management Practitioner; Christine Schuhmacher, MS, RN, Quality Management Practitioner; Lisa Sokoloff, BS, RN, CPHQ, Project Manager; David Harris, MS, CPHQ, Project Manager; Paul Murphy, BS, Data Manager; and William H. Greene, MD, former Chief Quality Officer for SBUH. The authors reported a 66.2 percent reduction in Stony Brook’s average central line-associated bloodstream infection (CLABSI) rate from 2008 to 2012, which resulted in an estimated decreased length of stay of 2.058 days and estimated savings of $13.6 million.
“Achieving and sustaining such a dramatic reduction in central line infections is a tremendous benefit to our patients and provides a roadmap for other hospitals to follow,” said L. Reuven Pasternak, MD, Vice President for Health Systems at Stony Brook Medicine and Chief Executive Officer for Stony Brook University Hospital. “This is a testament to the work of a dedicated team of Stony Brook clinicians over nearly a decade.”
The authors reported that, from 2007 to 2012, CLABSI rates at Stony Brook were reduced by 90.7 percent in the adult intensive care units (ICUs), and by 69.4 percent in the pediatric ICU, neonatal ICU and pediatric hematology/oncology unit. The authors further noted a 100 percent decrease from January to June 2012 in CLABSI rates for the hospital’s cardiac, neonatal and pediatric ICUs, as well as the pediatric hematology/oncology unit. During that same time period, the surgical, cardiothoracic and medical ICUs improved by 75.8 percent, 83.2 percent and 89 percent, respectively “Improvement efforts will continue until all CLABSIs are eliminated hospitalwide,” the authors wrote.
The authors stressed the importance of teamwork, leadership and ownership in achieving the improvements. The Performance Improvement (PI) team initially formed in 2004 included representatives from the medical staff, nursing, respiratory care, pharmacy, health care epidemiology, hospital administration and quality management. The PI team was led by the physician director of the SICU and the Chief of Surgery, with a quality management practitioner serving as project manager.
“A critical feature of our approach was to establish the ownership for effective leadership with the SICU physician and nursing directors with the explicit support of each director’s chief of service,” the authors concluded. “Indeed, the SICU leadership became avid proponents of the program, with buy-in and oversight through the multidisciplinary SICU collaborative team. The day-to-day involvement of this team … was instrumental in ensuring local buy-in….”
The authors added, “The success in the SICU, not only in terms of central lines but also in the promotion of interprofessional communication and the provision of timely, clinically relevant feedback data, led to an eagerness on the part of the leadership of the other ICUs to adopt the same PI methods.”
CAPTION: Stony Brook University Hospital staff and physicians who have participated in the initiative to reduce central line-associated bloodstream infection (CLABSI) rates from 2004 to 2012 include, front row, left to right, Christine Schuhmacher, RN, Lynn Antonawich, RN, Jennifer Muilenburg, RN, Melinda Monteforte, PharmD, Margaret Parker, MD, and Francina Singh, RN; and back row, left to right, Rob Garcia, Grace Propper, RN, Barbara Kranz, David Harris, James Vosswinkel, MD, and Paul Richman, MD.