Tab. II.
List and features of studies included.
| First author (year) | Country | Method | Outcome | Process | Pre | Post |
|---|---|---|---|---|---|---|
| Spear (2005) | USA | TPS | CLABSI | 1 CLABSI infections review of process in a group of hospitals. | 4.2/1,000 central line days | 1.9/1,000 central line days |
| Shannon (2006) | USA | TPS/Lean | HAI | 2 CLABSI infections review of process in 2 ICUs | 21.1/1,000 pt days | 3.33/1,000 pt days |
| CLABSI | 10.5/1,000 central line days | 1.2/1,000 central line days | ||||
| Mortality | 51% | 16% | ||||
| Shepler (2006) | USA | Lean | Satisfaction | 3 foot traffic in OR | 65% | 71% |
| Muder (2008) | USA | TPS | MRSA: ICU | 4 infection control in ICU and surgical unit of an hospital | 5.45/1,000 pt days | 1.35/1,000 pt days |
| Surgical Units | 1.56/1,000 pt days | 0.63/1,000 pt days | ||||
| Burkitt (2009) | USA | TPS/Lean | Compliance | 5 reduce MRSA infection on a surgical unit | 26% | 44% |
| Carboneau (2010) | USA | LSS | Hand Hygiene | 6 increase hand hygiene compliance AND reduce MRSA infections | 65% | 82% |
| MacRedmond (2010) | Canada | Lean/PDSA | Mortality Compliance: | 7 management protocol for sepsis in an hospital (ED+ICU) | 51.4% | 27% |
| -identification of potential septic pt | 75% | 92.3% | ||||
| -specificity of assessment | 91% | 90% | ||||
| McCulloch (2010) | UK | TPS/Lean | Hand Hygiene | 8 Patient safety protocol compliance in an emergency general surgery ward of an hospital | ||
| Compliance: | 23% | 31% | ||||
| -Administration | 35% | 87% | ||||
| -Correct use of protocol | 46% | 79% | ||||
| -Team Communication | 57% | 94% | ||||
| -Vital signs monitoring and recording | 68% | 99% | ||||
| -Pt without a drug prescription error | 47% | 60% | ||||
| -Completion of fluid balance | 89% | 90% | ||||
| Ellingson (2011) | USA | TPS | MRSA: | 9 reduce MRSA in an hospital through prevention of them | 2.28/1,000 pt days | 1.48/1,000 pt days |
| -Non intensive care surgical unit | ||||||
| -Surgical ICU | 3.73/1,000 pt days | 2.17/1,000 pt days | ||||
| -Remaining acute care units | 2.33/1,000 pt days | 1.39/1,000 pt days | ||||
| -Hospital wide | 2.40/1,000 pt days | 1.88/1,000 pt days | ||||
| Chassin (2013) | USA | LSS/Change Management | CD | 10 reduce HAIs | 8.98/10,000 pt days | 7.69/10,000 pt days |
| SSI | 15.80% | 10.70% | ||||
| Mortality | 16.44% | 12.83% | ||||
| Cima (2013) | USA | LSS | SSI | 11 reduce SSI in a tertiary care medical center | 9.8% | 4% |
| Dickson (2013) | USA | LSS | SSI | 12 reduce SSI in a community hospital | 4.07% | 1.93% |
| Martin (2013) | USA | TPS/Lean | CLABSI (travelling off the ICU) | 13 reduction of CLABSI for patient travelling of ICU | 14.1/1,000 pt days | 9.7/1,000 pt days |
| CLABSI (rates) | ||||||
| Compliance: | 3.5/1,000 central line days | 2.2/1,000 central line days | ||||
| -Clean medication admin | 23.2% | 93.0% | ||||
| -Clean cart touches | 41.8% | 92.3% | ||||
| -Clean airway procedures | 14.6% | 91.6% | ||||
| Chassin (2015) | USA | LSS/Change Management | Hand Hygiene | 14 improve hand hygiene in 8 hospitals | 48% | 81% |
| O’Reilly (2016) | USA | Lean | Compliance | 15 improve hand hygiene in ICU | 8% | 70% |
| Satisfaction (1/2) | 34% | 47% | ||||
| Satisfaction (2/2) | 49% | 70% | ||||
| Sirvent (2016) | EU | Lean | VAP | 16 improve flow of critical patients in ICU | 7.2/1,000 ventilator days | 5.2/1,000 ventilator days |
| CAUTI | 4.2/1,000 days of catheter | 4.3/1,000 days of catheter | ||||
| CLABSI | 0.95/1,000 central line days | 0.54/1,000 central line days | ||||
| Mortality | 18% | 21% | ||||
| Montella (2017) | EU | LSS | HAI (Surgical Dpt) | 17 reduce HAI in surgery departments | 0,37% | 0,21% |
| Horng (2018) | USA | Lean | Mortality | 18 optimize timely administration of antibiotics for patients with sepsis | 42,6% | 50,0% |
| Improta (2018) | EU | LSS | HAI (Medicine Dpt) | 19 reduce HAI in medicine areas | 0,36% | 0,19% |
| Ferrari (2019) | USA | Lean/EBP | CLABSI | 20 reduce CLABSI (8 procedures in one hospital) | 1.96/1,000 central line days | 1.02/1,000 central line days |
| Russell (2019) | USA | Lean/PDSA | CLABSI | 21 reduce CLABSI in ICU | 4.2/1,000 central line days | 1.8/1,000 central line days |
| Compliance | 25% | 67% | ||||
| Wolak (2019) | USA | Lean | CAUTI | 22 reduce CAUTI | 2.47/1,000 days of catheter | 1.46/1,000 days of catheter |
TPS: Toyota Production System; LSS: Lean Six Sigma; EBP: Evidence Based Practice; PDSA: Plan, Do, Study, Act; HAI: Hospital-acquired infection; CLABSI: central line associated blood stream infections; CAUTI: catheter-associated urinary tract infections; MRSA: methicillin resistant S. aureus; CD: C. difficile infections; SSI: surgical site infections; VAP: ventilator-associated pneumonia.