title: Eliminating hospital acquired infections: is it possible? Is it sustainable? Is it worth it?
abstract: An estimated 2 million hospital-acquired infections (HAI) are now reported annually in the US, and are associated with an estimated $5 billion in additional health care costs. With this, the growing incidence of HAI has become "ground zero" in the campaign to improve patient safety and eliminate waste in health care.We studied the characteristics of high-performing organizations and their leaders outside of health care to determine how such organizations become "best in class." We then sought to apply the principles that led to this status to eliminating HAI associated with central venous catheters.Observations of the current condition of health care revealed multiple defects in various processes, that were breeding grounds for error. Redesign of these processes by the people involved in them under the guidance of a leader resulted in an 86% reduction in infections in the blood. Overall, financial performance improved by $5.1 million over a 2-year period. Mortality in intensive care units declined by 29%.Using methods borrowed from highly reliable industries and engaging workers at the point of care can have profound and sustainable effects in nearly eliminating HAI, with significant clinical and financial benefits.
authors.affiliation: Hospital of the University of Pennsylvania, 3400 Spruce Street, Centrex 100, Philadelphia, PA 19104, USA. richard.shannon@uphs.upenn.edu
authors.forename: Richard P
authors.initials: RP
authors.lastname: Shannon
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D001291:Attitude of Health Personnel; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000191:economics / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000191:economics; D002983:Clinical Competence; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D004502:Education, Medical, Continuing; D007722:Health Knowledge, Attitudes, Practice; D017721:Hospital Costs; D006769:Hospitals, General / Q000191:economics; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods* / Q000592:standards; D018803:Models, Economic; D010414:Pennsylvania / Q000453:epidemiology; D016459:Prosthesis-Related Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D019984:Quality Indicators, Health Care / Q000191:economics