Hospitals in pursuit of excellence

A Hospital-Wide, Multidisciplinary Approach to Prevent Central-Line Infections

Stony Brook University Medical Center joined the Institute for Healthcare Improvement critical care collaborative in 2004 that incorporated application of central line and ventilator bundles, multidisciplinary rounding, and daily goal sheets to improve patient outcomes. The surgical intensive care unit was the first to form a performance improvement team to plan and deploy clinical practice recommendations. Over a two-year period, the initiative spread to the medical, pediatric, cardiac, and neonatal ICUs. Although initial success was achieved, the goal of eliminating central line infections was not. Stony Brook University Medical Center developed a standardized central line insertion credentialing program for its medical residents. All residents are expected to review an educational module, achieve a passing grade of 80 percent, and demonstrate competency in central line insertion on a simulator and at the bedside prior to credentialing. After further review of central line infection data, it became apparent that many of the lines became infected after day seven of insertion. Evaluation of the line maintenance process revealed staff were not accessing lines using the same level of sterile technique used during insertion. As a result, a central line maintenance protocol was developed and deployed. Due to these cumulative efforts, the hospital-wide central line-associated blood stream infection rates decreased by 59 percent over a five-year period.