The checklist contains five basic steps for doctors to follow when placing a central-line catheter: wash their hands; clean a patient's skin with chlorhexidine; wear a mask, hat, gown, and gloves and put sterile drapes over the patient; avoid placing a catheter in the groin where infection rates are higher and remove the catheter as soon as possible, even if there's a chance it might be needed again at some point.
Central lines are used regularly for patients in the ICU to administer medication or fluids, obtain blood tests, and directly gauge cardiovascular measurements such as central venous blood pressure. Each year roughly 80,000 patients become infected and 30,000 to 60,000 die at a cost of $3 billion nationally. Before heading to Michigan, Pronovost tested the checklist at Johns Hopkins Hospital, where catheter infections have also been virtually eliminated.
The new study covered more than 100 ICUs in the Michigan hospital system, which was a large pilot site for Pronovost's infection-prevention measures. Alongside the use of the cockpit-style checklist, the program included training physicians and nurses about infection control and using special, standardized central-line supply carts controlled for one-time use.
The safety plan also required immediate "stop now" orders by any member of the health care team when a checklist is not followed to the letter and feedback to each member of the care team about the number and rates of catheter-related bloodstream infections at weekly and quarterly meetings.
The Centers for Disease Control and Prevention estimates that between 10 percent and 20 percent of inpatients acquire some type of infection while in the hospital.
Before the checklist project in Michigan, the median rate of central-line infections there was about 3 per 1,000 catheter-hours, above the national average. After 18 months, mos
|Contact: Stephanie Desmon|
Johns Hopkins Medical Institutions