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;
2 Division of Pulmonary and Critical Care Medicine, Interventional Pulmonary, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ann Am Thorac Soc. 2015 Jun;12(6):847-53. doi: 10.1513/AnnalsATS.201411-511OC.
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.
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.
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.
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.
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.
带隧道留置胸膜导管已经改变了对与恶性胸腔积液相关的呼吸困难患者的治疗方法。然而，带隧道留置胸膜导管的放置并不能完全没有风险。最常报告的风险是感染。
本文旨在描述我们用于识别感染率的持续质量改进计划、为改进而实施的流程变化以及随后的结果。
确定 2009 年 5 月至 2014 年 4 月期间在约翰霍普金斯医疗中心接受带隧道留置胸膜导管放置的所有患者。主要结局是感染在干预前和干预组中的发生率。干预措施被确定为术前使用抗生素、完全无菌覆盖和将放置限制在一个单一的定义位置。
在研究期间，共对 201 例患者进行了 225 次带隧道留置胸膜导管放置，总体感染率为 5.8%。在干预前期间，进行了 134 次放置，而在干预期间进行了 91 次放置。在干预前组中，感染率为 8.2%，而在干预组中，感染率显著降低至 2.2%（P=0.049）。
使用持续质量改进计划审查带隧道留置胸膜导管的实践可以发现感染并发症，并采取措施改善患者的预后。
