Gilbert, C.R., Lee, H.J., Akulian, J.A., Hayes, M., Ortiz, R., Hashemi, D., . . . Yarmus, L.B. (2015). A quality improvement intervention to reduce indwelling tunneled pleural catheter infection rates. Annals of the American Thoracic Society, 12, 847–853. 

DOI Link

Study Purpose

To evaluate the effects of an organizational intervention to reduce pleural catheter infections

Intervention Characteristics/Basic Study Process

Medical records of patients receiving indwelling pleural catheters (IPC) for malignant effusions were reviewed to describe the overall findings and practices from 2009 to 2014. The protocol was then updated to include changes so that all placements occurred within a single location, all patients received perioperative antibiotics within 60 minutes prior to IPC insertion, and full body sterile draping was conducted. A review of all cases was done after six months of follow-up.

Sample Characteristics

  • N = 225   
  • MEAN AGE = 63 years
  • AGE RANGE = 22–93 years
  • MALES: 41.5%, FEMALES: 58.5%
  • CURRENT TREATMENT: Not applicable
  • KEY DISEASE CHARACTERISTICS: Of the patients, 88% had IPC insertion because of malignancy. Lung and breast cancer were most prevalent.

Setting

  • SITE: Single site   
  • SETTING TYPE: Multiple settings    
  • LOCATION: Johns Hopkins Medical Institution

Phase of Care and Clinical Applications

  • PHASE OF CARE: Late effects and survivorship

Study Design

  • Cohort comparison

Measurement Instruments/Methods

  • IPC infection defined as either cellulitis and/or tunnel infection
  • Pleural space infection defined by draining of pus from the pleural space or a positive culture of pleural fluid with associated clinical symptoms

Results

Overall, the IPC infection rate was 8.2% prior to the intervention and decreased to 2.2% after the intervention (p = 0.049).

Conclusions

The quality improvement interventions implemented were associated with a significant reduction in overall IPC infection rates.

Limitations

  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Measurement validity/reliability questionable
  • Reliance on medical records data

Nursing Implications

This study showed that a quality improvement intervention involving a review of practices and related outcomes and an implementation of protocol changes aimed at reducing IPC infection rates was successful because of the overall reduction of infection rates. Principles related to surgical site infection and catheter infection prevention were incorporated into the organizational protocol changes that were made.