• Christopher R Gilbert, Hans J Lee, Jason A Akulian, Margaret Hayes, Ricardo Ortiz, David Hashemi, Richard E Thompson, Sixto Arias, David J Feller-Kopman, and Lonny B Yarmus.
• 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;
• Ann Am Thorac Soc. 2015 Jun 1; 12 (6): 847-53.

RationaleThe 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.ObjectivesThe 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.MethodsAll 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.Measurements And Main ResultsA 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.ConclusionsThe 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.

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