title: A Quality Improvement Intervention to Reduce Indwelling Tunneled Pleural Catheter Infection Rates.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: 1 Penn State College of Medicine-Milton S. Hershey Medical Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Bronchoscopy and Interventional Pulmonology, Hershey, Pennsylvania;
authors: Christopher R
authors: CR
authors: Gilbert
authors: 2 Division of Pulmonary and Critical Care Medicine, Interventional Pulmonary, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Hans J
authors: HJ
authors: Lee
authors: 4 Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, University of North Carolina School of Medicine, Durham, North Carolina.
authors: Jason A
authors: JA
authors: Akulian
authors: 2 Division of Pulmonary and Critical Care Medicine, Interventional Pulmonary, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Margaret
authors: M
authors: Hayes
authors: 2 Division of Pulmonary and Critical Care Medicine, Interventional Pulmonary, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Ricardo
authors: R
authors: Ortiz
authors: 2 Division of Pulmonary and Critical Care Medicine, Interventional Pulmonary, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: David
authors: D
authors: Hashemi
authors: 3 Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors: Richard E
authors: RE
authors: Thompson
authors: 2 Division of Pulmonary and Critical Care Medicine, Interventional Pulmonary, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Sixto
authors: S
authors: Arias
authors: 2 Division of Pulmonary and Critical Care Medicine, Interventional Pulmonary, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: David J
authors: DJ
authors: Feller-Kopman
authors: 2 Division of Pulmonary and Critical Care Medicine, Interventional Pulmonary, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Lonny B
authors: LB
authors: Yarmus
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods / Q000706:statistics & numerical data; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods / Q000523:psychology; D063868:Patient Outcome Assessment; D016066:Pleural Effusion, Malignant / Q000175:diagnosis / Q000628:therapy; D058996:Quality Improvement; D011788:Quality of Life; D000069258:Thoracentesis / Q000009:adverse effects / Q000379:methods; D014481:United States / Q000453:epidemiology
keywords: indwelling tunneled pleural catheter; pleural infection; systems improvement