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Hospital Checklists Save Lives

  • Art Chimes

Simple things like hand washing and disinfecting the skin before a tube is inserted by needle into a patient’s vein, help reduce hospital infections.

Simple things like hand washing and disinfecting the skin before a tube is inserted by needle into a patient’s vein, help reduce hospital infections.

Simple measures such as hand washing and disinfecting skin make a difference

A new program to reduce hospital infections with relatively simple and inexpensive quality control measures is saving lives, according to a new study.

Hospitals can be dangerous places. We go there to get well, but sometimes people get sicker or even die because of infections they contract in the hospital.

Johns Hopkins University Medical School professor Peter Pronovost pioneered the use of hospital checklists to reduce infections.

He and his colleagues started with a list of about 90 recommendations from the U.S. Centers for Disease Control and Prevention, "and we elected to say, well, I can't do 90 things as a practicing [doctor]. Let me cull it out and pick the five most important things on that guideline and make sure we do those."

They focused their program on reducing infections in the central line, the tube inserted by needle into a patient’s vein to deliver medications and for other purposes. Central lines are a common source of serious infection in hospital intensive care units.

The checklist includes simple things like hand washing and disinfecting the skin before the central line is inserted. It has previously been shown to reduce the infection rate to near zero.

But did a lower infection rate translate to a lower death rate?

To find out, Pronovost and his colleagues compared hospital deaths in the state of Michigan, where the checklist program was in use, with nearby states that weren't in the program.

"What we found was that the mortality of patients in Michigan went down by 10 percent more than if they were in the 11 surrounding states."

While the quality improvement program may be built around a simple checklist, Pronovost stresses that it really is about changing how medical staff work together so that, for example, doctors listen to nurses, not just the other way around.

"A big part of our program was this culture change, because when doctors were using the checklist, 25 percent of the time they forgot [one of the items], so we asked the nurses to work with the doctors. And if the nurses saw the doctors not comply with the checklist, they can make the doctors go back and fix the mistake."

Pronovost says the quality improvement program is cost-effective and well-suited to resource-poor hospitals and clinics. "We've done it in Peru and we've just started a program in Pakistan and we're looking to put it into Africa. So it absolutely works."

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