Reducing the Healthcare-Associated Infections in a Rehabilitation Hospital under the Guidance of Lean Six Sigma and DMAIC.

Giuseppe Cesarelli,Rita Petrelli,Carlo Ricciardi,Mario Cesarelli,Giovanni D’Addio,Maria Ruccia,Orjela Monce

doi:10.3390/healthcare9121667

Abstract

The reduction of healthcare-associated infections (HAIs) is one of the most important issues in the healthcare context for every type of hospital. In three operational units of the Scientific Clinical Institutes Maugeri SpA SB, a rehabilitation hospital in Cassano delle Murge (Italy), some corrective measures were introduced in 2017 to reduce the occurrence of HAIs. Lean Six Sigma was used together with the Define, Measure, Analyze, Improve, Control (DMAIC) roadmap to analyze both the impact of such measures on HAIs and the length of hospital stay (LOS) in the Rehabilitative Cardiology, Rehabilitative Neurology, Functional Recovery and Rehabilitation units in the Medical Center for Intensive Rehabilitation. The data of 2415 patients were analyzed, considering the phases both before and after the introduction of the measures. The hospital experienced a LOS reduction in both patients with and without HAIs; in particular, Cardiology had the greatest reduction for patients with infections (−7 days). The overall decrease in HAIs in the hospital was 3.44%, going from 169 to 121 cases of infections. The noteworthy decrease in LOS implies an increase in admissions and in the turnover indicator of the hospital, which has a positive impact on the hospital management as well as on costs.

Highlights

The term “Healthcare-acquired infections” (HAIs)—equivalently, “Healthcare associated infections”—stands for a class of infective diseases that are not present or incubated at the time of admission to a hospital, as well as infections incubated following discharge, but referred to the incubation time at the shelter [1,2]
Current available literature has reported six types of infections, such as catheter-associated urinary tract infections (CAUTI) [4], surgical site infections, central line-associated bloodstream infections (CLABSI) [4], hospital-acquired pneumonia (HAP), ventilator-associated pneumonia, and Clostridium difficile [5,6] infections, which constitute more than the 80% of overall hospital infections [7]
We focus on hand hygiene, multidrug resistance, and Clostridium difficile, as well as the prevention of CLABSI, HAP, and CAUTI

Summary

Introduction

The term “Healthcare-acquired infections” (HAIs)—equivalently, “Healthcare associated infections”—stands for a class of infective diseases that are not present or incubated at the time of admission to a hospital, as well as infections incubated following discharge, but referred to the incubation time at the shelter [1,2]. HAIs do not involve patients alone and the hospital staff during everyday patient care [3]. The combination of different factors, e.g., a contaminated hospital environment, healthcare workers who act as a transmission vehicle, as well as the presence of different types of pathogens, may facilitate the transmission and persistence of multi-resistant organisms. Among identified pathogens in intensive care units, about 70% are resistant to at least one antibiotic [1]. For this reason, HAIs constitute a major public health problem and an economic burden in hospital care due to their significant impact on the subsequent increase in the length of hospitalization, morbidity, and mortality amongst hospitalized patients [8,9]. Rosenthal et al have recently estimated that 5% of hospitalized patients contract an infection during hospitalization, with a variable point prevalence between 7% and 9% of the hospitalized patients [10]

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Conclusion