Toyota Methods Yield Year With No Infections*

Good News… includes the story of measures led by Dr. Richard Shannon, director of medicine at Allegheny General Hospital, to eliminate bloodstream infections in the medical and coronary intensive care units. Physicians and nurses worked together to study each occurrence of a central line-associated infection (CLAB) and then design countermeasures that could become standard procedure. From 2003 to 2006 the two units achieved better than 95% reductions in infections and reduced deaths to zero.

From February 2006 to February 2007 the cardiac unit at Allegheny General had no CLABs.

The benefits included elimination of costs of $30-$50,000 per incident as well as reduction of time to change dressings from 15 to 5 minutes. From real-time data the team noticed non-standard procedures beginning in a month in which new residents arrived at the teaching hospital. New employees needed more thorough orientation then currently required..

Keys to improvement include:

• Observe the work in detail, and understand how to standardize processes.

• Collect data in real time, not waiting for quarterly, retrospective analyses.

• As soon as an infection is revealed, immediately examine how it happened; which procedures were not used or need to be changed.

The idea that “zero infections” is an achievable goal has extended to other hospital-acquired infections like ventilator-assisted pneumonia, antibiotic resistant MRSA and urinary tract infections.

Work on further quality improvements in CLAB cases continues.

* From PRHI Executive Summary, March/April 20l07 (www.prhi.org)