Program Reduces Serious Hospital Infections

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A U.S. program to help make sure hospital staff maintain strict hygiene standards lowered death rates in intensive care units by 10 percent, U.S. researchers reported.

Their study, published in the British Medical Journal, adds to a growing body of evidence that changing the hospital culture, including using checklists modeled on those employed by pilots, can reduce errors, saving lives and costs.

"What is breathtaking about this study is we knew it prevented infections, but we really didn't know for sure if it prevented deaths," Dr. Peter Pronovost of the Johns Hopkins University School of Medicine in Baltimore, who led the study, said in a telephone interview.

Provonost hopes the program, being rolled out in 40 states with funding from the U.S. Agency for Healthcare Research and Quality, can help the U.S. healthcare system save billions of dollars down the road.

His team looked at the impact of the initiative in intensive care units across Michigan.

They looked at the records of 1.3 million ICU patients aged over 65 -- who account for about half of all patients admitted to intensive care. They compared ICU death rates in Michigan to death rates in ICUs in surrounding states.

"Independent of whether they were in our program, mortality of all Medicare patients admitted to the ICU went down 10 percent compared to all 11 surrounding states -- that is incredible," Provonost said.

The program includes a simple five-point check list, but also a broader initiative, Provonost said.

"We also train (staff) in what we call the science of safety -- and a big part of that is that teams make wise decisions with diverse input. Doctors aren't trained to think that others have anything important to contribute," he said.

Johns Hopkins trains doctors to work more closely with nurses and other staff -- and to listen more to patients and their family members. They also give the hospitals feedback on their infection rates.

"It's the culture change that really made the difference, and feedback on infection rates," Provonost said.

Many studies have shown the infection rates in U.S. hospitals are high and getting worse. An estimated 80,000 patients given central lines into their bloodstreams become infected each year in U.S. hospitals and 31,000 of them die -- with associated costs as high as $3 billion.

In June, an analysis by Thomson Reuters showed the U.S. healthcare industry could cut $3.6 trillion in waste over 10 years with similar steps.

Central lines are thin plastic tubes used regularly for patients in ICUs to administer drugs or fluids, obtain blood for tests and directly measure blood pressure. The tubes are easily contaminated.

The checklist includes common-sense steps such as handwashing; using a disinfectant soap containing chlorhexidene; avoiding the use of a central line in a patient's groin area; regularly asking whether a catheter is still needed; and covering both the patient and staffer to avoid infection while inserting a catheter.