October 21, 2008

Common sense as infection control agent? Check.

What it means to you: If a new drug would help hospitals save thousands of lives and billions of dollars each year by significantly reducing the rate of healthcare-associated infections, every hospital in the U.S. would be clamoring to get their hands on it.

As it turns out, a simple checklist is doing all that. Dr. Peter Pronovost, a critical-care specialist at Johns Hopkins University, developed a five-item checklist for intensive-care staff to follow when inserting a central-line catheter. The five-item checklist contains nothing new (wash hands with soap, clean the patient’s skin with chlorhexidine, and so on), but Pronovost’s checklist helps clinicians remember these simple steps, and that is the key.

The scoop: Pronovost put his checklist to the test in 108 ICUs in Michigan and published the results in The New England Journal of Medicine. His findings almost defy belief; during the 18-month study period, the checklist led to about a 66 percent reduction in catheter-related bloodstream infections. As this New York Times story puts it, that equals more than 1,500 lives and nearly $200 million saved. The program cost only $500,000.

About half of intensive-care patients receive central-venous catheters. Of those, about 80,000 people a year become infected and 28,000 die, creating a $2.3 billion economic impact, according to Pronovost’s research. Until recently, such infections were considered an unfortunate yet generally accepted consequence of advanced life-saving medicine. After all, taking the time to follow proper hand hygiene when a patient is in cardiac arrest can seem counterproductive.

But the program was so successful that New Jersey, Rhode Island and Spain have begun using the checklist. After the program was featured in this New Yorker article, Pronovost was approached by healthcare authorities in California, Washington and Tennessee, as well. Last month, Pronovost was one of 25 Americans to receive a $500,000 “Genius” Fellowship from the MacArthur Foundation for his work to improve patient safety.

Learn more: Read about how New York hospitals reduced infection rates by adopting a checklist system based on Pronovost’s, and how two Michigan hospitals have adapted Pronovost’s checklist to reduce infections related to anesthesia equipment and ventilators.

Also, political columnist Kevin Drum speculates what Pronovost’s checklist could mean to the state of our nation’s health care in this CBSNews.com article.


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