After a number of heart attacks, the 60-year-old man desperately needed a heart transplant. But when he came under the care of cardiologist Richard P. Shannon at Allegheny General Hospital in Pittsburgh, he had a more immediate problem.
The man had developed a bloodstream infection from an IV - a so-called central line - designed to deliver a drug to keep his heart pumping. The infection forced him off the transplant list and killed him 17 days later.
"That man had waited more than 18 months for a new heart and the promise of a life," said Shannon, a heart-failure specialist now at the Hospital of the University of Pennsylvania. "His case showed we could no longer ignore line infections."
And it inspired Shannon to lead an effort at Allegheny General, borrowing industrial practices from Toyota Motor Corp. and Alcoa Inc., to standardize care and reduce infection rates. The results were dramatic. Bloodstream infections fell from 49 ICU patients in 2004 to six the following year.
Similar efforts are under way at hospitals across the Philadelphia region, from big academic medical centers such as Thomas Jefferson University Hospital to smaller ones such as Chester County Hospital.
It's good timing. Last month, Gov. Rendell targeted hospital-acquired infections, including central-line-associated sepsis, in his 47-point plan to improve health care in the state.
"We think Pennsylvania is going to be the first state to work together with industry to make our hospitals the safest in the country," said Ann S. Torregrossa, senior policy director in the Governor's Office of Healthcare Reform.
Central lines are catheters placed in a main vein or artery to administer substantial amounts of medications or nutrients. Patients who get central lines tend to be sicker; at some hospitals, 50 percent or more of the people in the ICU have central lines, compared with 10 percent on the main floors.
Central-line-associated bloodstream infections are among the most common, costly and deadly complications of hospital care.
Rendell wants to use the state's clout as the biggest purchaser of hospital care to reduce these infections, which add billions to health costs and lead to preventable deaths and illnesses.
"This is not rocket science," Torregrossa said. "It requires a culture change and a standardized way of doing procedures."
Ultimately, if Rendell's proposals are enacted, the state would stop paying the added cost of these infections. But in a carrot-and-stick approach, Rendell also seeks to create financial rewards for hospitals that lower their infection rates.
"The governor wants to pull together the largest payers across the state so that we are all giving the same financial incentives for progress," Torregrossa said. "There would be more than enough money to provide performance bonuses and still save money if we get these infections rates down."
In the Philadelphia area, hospitals are already seeing results from efforts to solve the problem.
The Partnership for Patient Care, an initiative launched in 2005 by the Delaware Valley Healthcare Council and Independence Blue Cross, identified specific steps hospitals could take to reduce infections.
The key is to standardize the practice whenever a central line is placed.
In 2005, Chester County Hospital implemented a series of evidence-based practices, called a bundle, developed by the Institute for Healthcare Improvement in Cambridge, Mass. The 234-bed community hospital lowered its central-line-associated bloodstream infection rate 25 percent in 2006.
Before implementing the bundle, no one at the hospital wore a cap. Now, each line is placed using a completely sterile process.
Patients are draped from head to foot with only a small hole near the shoulder where the central line is threaded into a main vessel.
Today, a special antiseptic is used in all cases, and health providers must wait several minutes for the antiseptic to dry. Nurses and other personnel are empowered to stop if sterility is breached.
"We standardized our processes and are working to ensure that we insert central lines the same way every time," said Charleen Faucette, infection-control specialist at Chester County.
Further, patients are checked each day to determine if the central line is still needed. As a result, in 2006 the number of days the lines were in patients fell 10 percent, to 8,290.
That is a fraction of the number of "line-days" at a hospital like Penn, where the number of days patients have central lines totals about 70,000 a year.
Penn has also had success at reducing infections. In January, central-line-associated bloodstream infections were 30 percent lower than in 2005 at the Hospital of the University of Pennsylvania, said chief medical officer P.J. Brennan.
At Pennsylvania Hospital, there were no bloodstream infections last month at the 515-bed facility, which is part of Penn's system.
It's all part of a larger patient-safety program to "ensure that preventable events don't happen," Brennan said.
At Main Line Health's three suburban hospitals - Bryn Mawr, Paoli, and Lankenau in Wynnewood - infection control extends to the patient's entire hospital stay.
"My goal has always been to prevent the first complication," said Thomas G. McCarter, Main Line's chief medical officer. "When we get a patient through the system faster, it is less likely there will be a second complication like an infection."
Despite the improvements, patient-safety experts say there is room for more, even though Pennsylvania has become a national leader on the issue.
Last year, the state was the first to publicly report infection rates by hospital, when the Pennsylvania Health Care Cost Containment Council issued its seminal report detailing the problem.
"We are starting to see real results," said Marc P. Volavka, executive director of the Cost Containment Council, an independent state agency. "One hospital had a 70 percent reduction in urinary-tract infections."