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Safety Checklist Shows Effect
Hospital infections: five basic
steps and a culture change may
decrease the number; © SXC
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 is a chance it might be needed again at some point.
The new study covered more than 100 intensive care units (ICUs) in the Michigan hospital system. Alongside the use of the cockpit-style checklist, the programme included training physicians and nurses about infection control and using special, standardised 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.
Before the checklist project in Michigan, the median rate of central-line infections there was about three per 1,000 catheter-hours, above the national average. After 18 months, most Michigan ICUs reported none of these bloodstream infections. The new research shows that after three years, the same was true.
The key to success is not just following standardised checklist steps, says Peter Pronovost, the report's leader and the developer of the checklist. To change culture, what is more important is that hospitals also search for errors on a continuing basis, know their infection rates and monitor them after implementing safety innovations. Doctors and nurses need to know the measures they are taking are working, to realise that the science behind the checklist is valid, he says.
Culture change means a work environment in which "nurses question doctors who do not wash their hands or use the checklist diligently," says Pronovost . "It means clinicians no longer thinking central-line infections are inevitable. They believe these infections are preventable and they are creating a culture where they are," he adds.
MEDICA.de; Source: Johns Hopkins Medical Institutions