Maryland hospitals join national effort to reduce infections

Maryland, trying to combat one of the highest growth rates of bloodstream infections in the country, is joining the national effort to curb the problem by adopting a prevention program created by a Johns Hopkins doctor.

Forty-four Maryland hospitals recently announced they will institute measures developed by Hopkins critical-care doctor Peter Pronovost. His highly recognized approach has helped decrease infections in other states.

Pronovost and his team created the program nearly nine years ago that calls for simple steps to curb blood infections — usually associated with catheters. The steps call for things such as thoroughly washing hands, using certain cleaners to swab an area before inserting a catheter and making sure the catheter is inserted correctly. Pronovost's approach also calls for aggressive reporting standards and taking steps to change the culture at hospitals that influences the way employees look at infections.

The program is reaching new milestones, with 30 states signing on to institute the measures created by Pronovost. This summer. federal health officials made it a goal to reduce bloodstream infections by 50 percent in the next three years.

"What is novel now is we are putting it in across the country," Pronovost said in a telephone interview. "It's the first quantitative outcome goal for quality and safety that the country has ever made. We have never really committed to something measureable until now."

Nearly 250,000 people get bloodstream infections in hospitals each year, with about 30,000 dying from them, Pronovost said. The infections are often linked to central line or central vascular catheters used to administer medicine, nutrients, fluid or blood over a long period of time. Bacteria, some resistant to antibiotics, often develop around the tubes.

Pronovost and his team began testing his prevention program at Hopkins nine years ago before rolling it out at nearly 100 intensive care units at 70 Michigan hospitals. After six months, 103 intensive care units at the Michigan hospitals dropped their infection rates by 60 percent. It has also been tested in 10 other states.

"It has worked in other states," said Jim Reiter, a spokesman with the Maryland Hospital Association. "We just wanted to sign on because it is proven."

Many of Maryland hospitals already had programs to reduce infections, and since 2008 have been required to report the number of infections to the Maryland Health Care Commission.

About 38 hospitals entered into a collaborative effort for a year in 2005 to improve bloodstream infection rates, and many kept their procedures after the program ended. At Sinai Hospital, for instance, the chief of medicine makes regular inspections of catheters to ensure they're inserted correctly or the proper type is used. But Provost's program is the most concerted effort with proven success.

Still, the federal Centers for Disease Control said that between 2007 and 2009, Maryland had the highest rate of increase in central-line bloodstream infections among 17 states surveyed, with a 30 percent increase in catheter-related infections. Most of the states surveyed showed improvements. New statistics are expected to be released by the CDC later this year.

Maryland had 222 preventable infections between January 2009 and June 2009, according to the Maryland Hospital Association.

The Maryland Hospital Association has a goal of reducing the number of infections caused by catheters to zero in the next three years, according to Barbara Epke, a vice president with LifeBridge Health and chair of MHA's council on clinical and quality issues.

She said the efforts hospitals had taken wouldn't have shown up in the most recent statistics. Maryland hospitals expect using Pronovost's program will help reduce infections even more.

"We're all very diligently looking at this, but the Pronovost program will allow us to take what we have done and move it to the next level," Epke said. "It's something we can really control but it takes a tremendous amount of work and initiative and a lot of thoroughness."

The Maryland Patient Safety Center thinks adopting the Pronovost program will help save lives.

"You don't want patients coming in getting sicker than they were on the outside," said Patrick Chaulk, executive director and president of the Maryland Patient Safety Center. "This is going to reduce errors and preventive problems in the hospital."

Pronovost likened the effort to the polio campaign. Because of his research, he was named one of Time magazine's most influential people in the world in 2008 and he also received a prestigious MacArthur Foundation genius award.

"The goal is to get these infections down as quickly and broadly as possible," he said.

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