Basic procedures cut hospital infections

Baltimore Sun

A study by Johns Hopkins researchers offers strong evidence that careful adherence to a few simple and cheap procedures -- as basic as hand-washing -- can drastically reduce the spread of infection in hospitals.

The researchers tracked infection rates in Michigan hospitals that had agreed to institute strict safety practices for catheters, which are small tubes inserted into patients' veins. Used to administer medication and nutrients to some patients, the tubes can also be the source of life-threatening infections.

A year and a half after the changes were made, the rates of catheter-related bloodstream infections dropped by 66%, according to the study, published today in the New England Journal of Medicine.

"The results are pretty breathtaking," said Dr. Peter Pronovost, the lead author and a professor of anesthesiology and critical care medicine at Johns Hopkins University's School of Medicine. "The numbers of infections went down quickly and they stayed down."

He said the catheter protocols studied in Michigan hold broader lessons for curbing the spread of germs in hospitals nationwide.

The Centers for Disease Control and Prevention estimates that 90,000 Americans die every year from infections they contract while hospitalized.

Public outcry in Maryland and elsewhere led that state's General Assembly to pass a law last spring requiring certain healthcare facilities to track and report hospital-acquired infections.

Because many such infections are thought to result from antibiotic-resistant organisms, hospitals have been searching for ways to prevent the spread of the germs without relying on drugs.

This summer, Baltimore's Franklin Square Hospital and Johns Hopkins began a two-year pilot project to test methods that include stricter hygiene protocols.

Pronovost said his study in Michigan proved the effectiveness of simple measures. "We think this model really helps to advance the science of patient safety," he said. "It shows what's possible. We no longer have to accept the infections as inevitable."

To ensure that doctors and nurses adhered to the safety protocols, the researchers instituted a team approach comparable to that used by airplane pilots and in the business world. This included setting daily performance goals and following checklists.

The Johns Hopkins team focused on improving the safety of central venous catheters, a type that is inserted into most patients treated in intensive-care units.

About 80,000 ICU patients contract infections from bacteria that contaminate such catheters every year, and about 35% of those patients die from the infections, according to estimates of the CDC. Treating a patient for catheter-related infection is estimated to cost $45,000 on average.

To reduce the numbers of catheter-related infections, the Johns Hopkins researchers formed teams of doctors and nurses at more than 100 intensive care units.

The teams implemented several precautions known to be effective.

These included rigorous hand-washing, thorough cleaning of the skin around catheters, and wearing sterile masks, gowns and gloves. Doctors removed catheters from patients as soon as possible and avoided inserting catheters in the groin area.

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