How effective are check lists? Pilots know they are effective and now medical experts do too, according to a new study published in the British Medical Journal. A refreshing culture change in Michigan hospitals, including adherence to a simple, five-part check list is associated with reduced infections and a 10 percent reduction in infection-related deaths in intensive care units (ICUs) among patients 65 years old and older. The check list for healthcare professionals comprises common sense, low cost quality improvement measures to prevent catheter-related bloodstream infections, also known as Central Line Associated Bloodstream Infections (CLABSI):
√ Wash Hands
√ Use a Cap, Gown and Mask
√ Clean Patients’ Skin with a Disinfectant (e.g., chlorhexidine)
√ Avoid Placing Catheters near the Groin
√ Remove Unnecessary Catheters
The Michigan study is part of the Keystone ICU Project, which promotes a “culture of safety” among healthcare professionals by focusing on safety education, identifying potential safety problems, developing evidence-based solutions, and measuring improvements. Hospitals are given feedback on infection rates and all caregivers, regardless of rank, are empowered to question one another and stop procedures if safety is compromised.
There is a growing concern over rising infection rates in U.S. hospitals. A Johns Hopkins press release noted, “Experts say an estimated 80,000 patients a year with central lines [blood stream catheters] get infected, some 31,000 die — nearly as many as die from breast cancer annually — and the cost of treating them may be as high as $3 billion nationally.” Without strict attention to hygiene, catheters are easily contaminated, leading to patient infection.
In the large “retrospective,” case-controlled study, the medical records of 1.3 million ICU patients in 95 Michigan hospitals were accessed and compared to similar data in 11 surrounding states. Retrospective studies examine events that have already happened. In this case, patient records provided the data that showed ICU patient bloodstream infections were virtually eliminated in study hospitals compared to hospitals not participating in the study.
Principal investigator Dr. Peter Pronovost of Johns Hopkins said in a Reuters interview, it has been known that measures taken in the study reduce infections, but the “breathtaking” aspect of this study is that it showed these measures prevent deaths. Provonost highlighted the two things: the culture change and giving hospitals feedback on infection rates as “really making the difference.”
Jerod M. Loeb, Ph.D. is Executive Vice President, Healthcare Quality Evaluation at The Joint Commission in Oakbrook Terrace, Illinois