Speaking Up for Patient Safety, and Survival

Health care workers’ failure to clean their hands is the most important cause of hospital-based infections, which are the fourth-leading cause of death in America and cost our health care system some $40 billion a year.

Routine hand-washing before and after seeing each patient — the type of hand hygiene these technological systems are targeting — is likely the most resistant to improvement.   It has to be done dozens or hundreds of times a day by busy health care workers who may be doing two or three things at once and have their hands full of supplies.

There are, however, other hospital situations that are high-risk for patient infection where progress has been remarkable.  In 2003, the Michigan Health and Hospital Association began an experiment to see if its members could bring down the rate of infection in central line catheters — one of the deadliest types of hospital-acquired infections.

The intensive care units at nearly every hospital in Michigan participated — 103 I.C.U.’s.   What they had to do was use a five-point checklist to prevent infection when inserting the catheters.   The steps were:   Wash hands. Cover the patient with sterile drapes.  Clean the skin with chlorhexidine antiseptic.  Do not insert catheters into the groin area.  Remove catheters as soon as they are no longer needed.

A paper in the New England Journal of Medicine by Peter Pronovost, the Johns Hopkins University doctor who designed the checklist, set out the results.  “Within 3 months after implementation, the median rate of infection was 0, a rate sustained throughout the remaining 15 months of follow-up. All types of participating hospitals realized a similar improvement.”

The median rate of infection dropped to zero.  The study shows that central line bloodstream infections are preventable.  Michigan hospitals then did the same thing to prevent ventilator-associated pneumonia, another very dangerous infection.  The results were exactly the same.

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