This is a call to arms for everyone who may someday be hospitalized, or who has a relative who may someday be hospitalized - which is to say everyone.
These days, to spend time in the hospital is to be at risk of contracting a hospital-acquired infection. Some of these infections can be life threatening. But there is a simple way to make that hospital stay safer, devised by Peter Pronovost, a physician-researcher at Johns Hopkins.
The method - a five-item checklist to assure that proper precautions are taken to prevent infection - has been thoroughly tested, first at Johns Hopkins and later in 108 intensive-care units in Michigan, where it succeeded beyond anyone's wildest dreams in saving lives and reducing costs for patients who received the major fluid tube called a central venous catheter.
According to Pronovost, whose findings in Michigan were published in The New England Journal of Medicine on Dec. 28, 2006, about half of intensive-care patients receive these catheters; about 80,000 a year become infected and 28,000 die, with an economic cost of US$2.3 billion.
FIVE SIMPLE STEPS
Using the checklist, in 18 months the average ICU at these diverse hospitals reduced its catheter-related infection rate to zero, from 4 percent. All told, the checklist saved more than 1,500 lives and nearly US$200 million. The program itself cost only US$500,000.
Pronovost, a professor of anesthesiology and critical care medicine, said in an interview that he distilled the five steps from a 64-page federal document on controlling hospital-acquired infections. When inserting a central venous catheter, doctors should do the following:
1. Wash their hands with soap.
2. Clean the patient's skin with chlorhexidine antiseptic.
3. Put sterile drapes over the entire patient.
4. Wear a sterile mask, hat, gown and gloves.
5. Put a sterile dressing over the catheter site.
To someone on the outside, this list may seem like a no-brainer. But in the crush of crisis medicine, one or more of these steps is often neglected, sometimes with disastrous results. What made the program work in Michigan was continuous - and anonymous - collection of data. The hospitals were monitored on their use of the list, their rates of infection and their feedback to medical personnel to show what was working and where gaps remained in quality care.
The task now is to expand the checklist concept to other procedures and to get hospitals throughout the country to adopt it. New Jersey and Rhode Island are already planning to use it. And following a report on the checklist in the Dec. 10, 2007, issue of The New Yorker by Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston, Massachusetts, Pronovost said he had been approached by health care authorities in California, Washington and Tennessee seeking the program for their states. Spain is adopting the program nationwide, and the World Health Organization is hoping to take it global.
As Pronovost explained, medical research must go beyond understanding the biology of disease and devising effective therapies.
"We have to assure that we deliver those therapies safely and effectively, but research examining 300 quality measures showed that patients receive adequate therapy only about half the time," he said.
"My approach was to figure out what it takes to change behavior," Pronovost said. "This represents the biggest opportunity to improve health - making sure that what we know works is delivered safely, effectively and efficiently."
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