Central Line Infection Update

I have been writing for many months about our efforts to eliminate central line infections, starting with this post in December of 2006, and then giving periodic updates on this blog. Now, there is a regular feature on the BIDMC website where people can check in on this and other clinical indicators.

But we received a report yesterday that I have to share in this forum again. The chart above shows the year-by-year number of central line infections at BIDMC, as measured in cases per 1000 patient days in our intensive care units. Clear and steady progress over the last several years is evident, and I have to admit that I am really proud of our folks -- nurses, doctors, residents, and others -- in our ICUs.

What does this mean in real terms? Well, in a typical month, there might be 1500 patient days in our ICUs. With a drop in our infection rate from over 4.0 to under 1.0, it means that more than 4 people per month (.003 x 1500) did not get a central line infection. With a mortality rate of, say, 20% among those getting such infections, it means we are saving the equivalent of roughly one life per month.

This also saves lots of dollars, mainly for the insurance companies and governments who pay for the extended stays that result from infections. It also frees up scarce ICU capacity for seriously ill patients who show up in our Emergency Department or are otherwise admitted to the hospital.

What's left? What does it take to get to zero? Frankly, we are not sure. There is no distinct pattern of causality among the cases we still see -- and we evaluate each and every one. I'd love to hear from others out there who have also been successful on this front if they want to offer comments on anything we might want to consider to achieve our ultimate goal of a sustained "zero".