A Quality Improvement Intervention to Reduce Indwelling Tunneled Pleural Catheter Infection Rates
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. The aim of this paper is to descr...
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| Veröffentlicht in: | Annals of the American Thoracic Society 2015-06, Vol.12 (6), p.847-853 |
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| creator | Gilbert, Christopher R Lee, Hans J Akulian, Jason A Hayes, Margaret Ortiz, Ricardo Hashemi, David Thompson, Richard E Arias, Sixto Feller-Kopman, David J Yarmus, Lonny B |
| description | 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.
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.
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.
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.
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. |
| doi_str_mv | 10.1513/AnnalsATS.201411-511OC |
| format | Article |
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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.
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.
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.
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.</description><identifier>ISSN: 2329-6933</identifier><identifier>EISSN: 2325-6621</identifier><identifier>DOI: 10.1513/AnnalsATS.201411-511OC</identifier><identifier>PMID: 25871702</identifier><language>eng</language><publisher>United States: American Thoracic Society</publisher><subject>Antibiotic Prophylaxis - methods ; Antibiotic Prophylaxis - statistics & numerical data ; Catheter-Related Infections - epidemiology ; Catheter-Related Infections - etiology ; Catheter-Related Infections - prevention & control ; Catheters, Indwelling - adverse effects ; Female ; Humans ; Incidence ; Infection Control - methods ; Infection Control - statistics & numerical data ; Male ; Middle Aged ; Palliative Care - methods ; Palliative Care - psychology ; Patient Outcome Assessment ; Pleural Effusion, Malignant - diagnosis ; Pleural Effusion, Malignant - therapy ; Quality Improvement ; Quality of Life ; Thoracentesis - adverse effects ; Thoracentesis - methods ; United States - epidemiology</subject><ispartof>Annals of the American Thoracic Society, 2015-06, Vol.12 (6), p.847-853</ispartof><rights>Copyright American Thoracic Society Jun 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c339t-7e6c475cccc1e500652fcae23241a1b45f7f609c99dee8b0aa649f1b3e319e753</citedby><cites>FETCH-LOGICAL-c339t-7e6c475cccc1e500652fcae23241a1b45f7f609c99dee8b0aa649f1b3e319e753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25871702$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gilbert, Christopher R</creatorcontrib><creatorcontrib>Lee, Hans J</creatorcontrib><creatorcontrib>Akulian, Jason A</creatorcontrib><creatorcontrib>Hayes, Margaret</creatorcontrib><creatorcontrib>Ortiz, Ricardo</creatorcontrib><creatorcontrib>Hashemi, David</creatorcontrib><creatorcontrib>Thompson, Richard E</creatorcontrib><creatorcontrib>Arias, Sixto</creatorcontrib><creatorcontrib>Feller-Kopman, David J</creatorcontrib><creatorcontrib>Yarmus, Lonny B</creatorcontrib><title>A Quality Improvement Intervention to Reduce Indwelling Tunneled Pleural Catheter Infection Rates</title><title>Annals of the American Thoracic Society</title><addtitle>Ann Am Thorac Soc</addtitle><description>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.
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.
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.
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.
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.</description><subject>Antibiotic Prophylaxis - methods</subject><subject>Antibiotic Prophylaxis - statistics & numerical data</subject><subject>Catheter-Related Infections - epidemiology</subject><subject>Catheter-Related Infections - etiology</subject><subject>Catheter-Related Infections - prevention & control</subject><subject>Catheters, Indwelling - adverse effects</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infection Control - methods</subject><subject>Infection Control - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Palliative Care - methods</subject><subject>Palliative Care - psychology</subject><subject>Patient Outcome Assessment</subject><subject>Pleural Effusion, Malignant - diagnosis</subject><subject>Pleural Effusion, Malignant - therapy</subject><subject>Quality Improvement</subject><subject>Quality of Life</subject><subject>Thoracentesis - adverse effects</subject><subject>Thoracentesis - methods</subject><subject>United States - epidemiology</subject><issn>2329-6933</issn><issn>2325-6621</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpdkV9PwjAUxRujEYJ8BbLEF1-Gve3arY-E-IeEBEV8Xkp3pyNbh-uG4dtbQHnwvvSm-Z2Te-8hZAR0DAL4_cRaXbrJ6m3MKEQAoQBYTC9In3EmQikZXB57FUrFeY8MndtQX4mAJFbXpMdEEkNMWZ_oSfDa6bJo98Gs2jb1Diu0bTCzLTY73xW1Ddo6WGLWGfTf2TeWZWE_glVnLZaYBS8ldo0ug6luP9GrPJSjOQqXukV3Q65yPy0Of98BeX98WE2fw_niaTadzEPDuWrDGKWJYmF8AQpKpWC50ei3iEDDOhJ5nEuqjFIZYrKmWstI5bDmyEFhLPiA3J18_RZfHbo2rQpn_LTaYt25FGSiJItYEnv09h-6qbvmcFNPKZYAeE9PyRNlmtq5BvN02xSVbvYp0PSQQ3rOIT3lkB5z8MLRr323rjA7y_6uzn8A01qF6w</recordid><startdate>201506</startdate><enddate>201506</enddate><creator>Gilbert, Christopher R</creator><creator>Lee, Hans J</creator><creator>Akulian, Jason A</creator><creator>Hayes, Margaret</creator><creator>Ortiz, Ricardo</creator><creator>Hashemi, David</creator><creator>Thompson, Richard E</creator><creator>Arias, Sixto</creator><creator>Feller-Kopman, David J</creator><creator>Yarmus, Lonny B</creator><general>American Thoracic Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201506</creationdate><title>A Quality Improvement Intervention to Reduce Indwelling Tunneled Pleural Catheter Infection Rates</title><author>Gilbert, Christopher R ; Lee, Hans J ; Akulian, Jason A ; Hayes, Margaret ; Ortiz, Ricardo ; Hashemi, David ; Thompson, Richard E ; Arias, Sixto ; Feller-Kopman, David J ; Yarmus, Lonny B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c339t-7e6c475cccc1e500652fcae23241a1b45f7f609c99dee8b0aa649f1b3e319e753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Antibiotic Prophylaxis - methods</topic><topic>Antibiotic Prophylaxis - statistics & numerical data</topic><topic>Catheter-Related Infections - epidemiology</topic><topic>Catheter-Related Infections - etiology</topic><topic>Catheter-Related Infections - prevention & control</topic><topic>Catheters, Indwelling - adverse effects</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infection Control - methods</topic><topic>Infection Control - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Palliative Care - methods</topic><topic>Palliative Care - psychology</topic><topic>Patient Outcome Assessment</topic><topic>Pleural Effusion, Malignant - diagnosis</topic><topic>Pleural Effusion, Malignant - therapy</topic><topic>Quality Improvement</topic><topic>Quality of Life</topic><topic>Thoracentesis - adverse effects</topic><topic>Thoracentesis - methods</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gilbert, Christopher R</creatorcontrib><creatorcontrib>Lee, Hans J</creatorcontrib><creatorcontrib>Akulian, Jason A</creatorcontrib><creatorcontrib>Hayes, Margaret</creatorcontrib><creatorcontrib>Ortiz, Ricardo</creatorcontrib><creatorcontrib>Hashemi, David</creatorcontrib><creatorcontrib>Thompson, Richard E</creatorcontrib><creatorcontrib>Arias, Sixto</creatorcontrib><creatorcontrib>Feller-Kopman, David J</creatorcontrib><creatorcontrib>Yarmus, Lonny B</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of the American Thoracic Society</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gilbert, Christopher R</au><au>Lee, Hans J</au><au>Akulian, Jason A</au><au>Hayes, Margaret</au><au>Ortiz, Ricardo</au><au>Hashemi, David</au><au>Thompson, Richard E</au><au>Arias, Sixto</au><au>Feller-Kopman, David J</au><au>Yarmus, Lonny B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Quality Improvement Intervention to Reduce Indwelling Tunneled Pleural Catheter Infection Rates</atitle><jtitle>Annals of the American Thoracic Society</jtitle><addtitle>Ann Am Thorac Soc</addtitle><date>2015-06</date><risdate>2015</risdate><volume>12</volume><issue>6</issue><spage>847</spage><epage>853</epage><pages>847-853</pages><issn>2329-6933</issn><eissn>2325-6621</eissn><abstract>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.
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.
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.
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.
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.</abstract><cop>United States</cop><pub>American Thoracic Society</pub><pmid>25871702</pmid><doi>10.1513/AnnalsATS.201411-511OC</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; Journals@Ovid Complete; American Thoracic Society (ATS) Journals Online; Alma/SFX Local Collection |
| subjects | Antibiotic Prophylaxis - methods Antibiotic Prophylaxis - statistics & numerical data Catheter-Related Infections - epidemiology Catheter-Related Infections - etiology Catheter-Related Infections - prevention & control Catheters, Indwelling - adverse effects Female Humans Incidence Infection Control - methods Infection Control - statistics & numerical data Male Middle Aged Palliative Care - methods Palliative Care - psychology Patient Outcome Assessment Pleural Effusion, Malignant - diagnosis Pleural Effusion, Malignant - therapy Quality Improvement Quality of Life Thoracentesis - adverse effects Thoracentesis - methods United States - epidemiology |
| title | A Quality Improvement Intervention to Reduce Indwelling Tunneled Pleural Catheter Infection Rates |
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