Study: Hospital anti-infection effort saves lives

Hopkins doctor's plan, now nearly nationwide, reduced patient deaths in Michigan

January 31, 2011|By Timothy B. Wheeler, The Baltimore Sun

A new study finds that a safety checklist program developed by a Johns Hopkins doctor has reduced patient deaths in Michigan hospitals by 10 percent, in addition to nearly eliminating bloodstream infections in health care facilities that embraced the prevention effort.

The research, published in the British Medical Journal, is the first to show a drop in patient mortality in hospitals using the Hopkins program. Previous studies have found major reductions in bloodstream infections from using the checklist when inserting catheters or central lines to give patients medication, fluids or nourishment.

"We knew that it reduced infections, but we didn't know that it saves lives," said Dr. Peter Pronovost, professor of anesthesiology and critical care medicine at Hopkins' medical school and the leader of the study.

The findings are likely to spur the nationwide spread of the infection prevention program, which has now been adopted by hospitals in more than 40 states, including in Maryland, which saw a spike in central-line bloodstream infections from 2007 to 2009.

Pronovost and his team developed the checklist nine years ago, along with a training program that attempts to change the culture in hospitals so staff will speak up if patient-safety rules aren't being followed. The checklist ticks off five basic precautions, such as washing hands, to prevent the spread of germs.

The program got its first widespread tryout in Michigan, where Pronovost said 70 percent of the state's hospitals put it into practice starting in 2004.

To assess its impact, Pronovost and colleagues looked at elderly patients admitted to intensive care units in Michigan hospitals, compared with those placed in hospital ICUs in 11 surrounding states. Although hospital infections occur in patients of all ages, the researchers focused on patients 65 years and older because data on them were readily accessible via the federal Medicare program, Pronovost explained.

The study did not find any significant difference in the length of hospital stay by elderly patients in Michigan and in surrounding states. But it did detect a variation in death rates. Deaths declined slightly among elderly intensive-care patients in the other states, for unknown reasons, Pronovost said. But mortality dropped by 10 percent more in Michigan, he noted.

"Prior to our study, the mortality rates in Michigan and surrounding states were quite similar," the researcher said. Those death rates diverged once Michigan hospitals began using the prevention program.

"It's breathtaking," Pronovost said. "With our program, patients are alive who wouldn't be if they were outside Michigan."

Nearly 250,000 patients get bloodstream infections in hospitals annually, health experts estimate, with about 30,000 dying from them each year.

Pronovost said that hospitals in 47 states have signed up for the Hopkins-developed infection prevention program. So far, about 38 have actually begun the two-year training regimen that goes along with using the checklist.

In Maryland, all but five of the state's 46 acute-care hospitals joined the effort last fall, according to Jim Reiter, spokesman for the Maryland Hospital Association. The first training meeting was in December.

Maryland's hospitals joined the effort about the time the federal Centers for Disease Control and Prevention released data showing the state had the highest rate of increase in bloodstream infections among 17 states surveyed — a 30 percent jump between 2007 and 2009.

"You don't feel good when you see statistics like that," said the hospital association's Reiter. Still, he noted that Maryland has been a national leader in pushing for greater patient safety.

"This is a very effective program," the spokesman said, though he noted that "it takes work."

"The culture change is just something that's slowly having to happen," he concluded.

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