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A checklist that can save lives

The Baltimore Sun

When Dr. Peter J. Pronovost began looking at ways to combat hospital-related infections, physicians and other colleagues almost always had a ready response: Infections were inevitable in caring for thousands of sick patients every year. But the Johns Hopkins physician didn't see it that way and developed a five-step program to prevent dangerous infections contracted in hospitals, research that recently earned him a prestigious MacArthur Foundation genius award. These simple measures have been shown to save lives, and more hospitals should adopt them.

A recent congressional study estimated that a prevention program developed by Dr. Pronovost could save an additional 15,680 lives nationally and an estimated $1.3 billion in costs if used by all states. The September report by the Committee on Oversight and Government Reform surveyed hospital associations and found that only 14 states were using or planned to use the Pronovost program to help prevent patient infections that develop from the use of catheters in intensive care units. The program relies on steps as simple as washing hands and using proven cleaners to swab an area before inserting a catheter, and a checklist that ensures that medical professionals complete the five steps.

The results of the checklist are readily apparent in Michigan, where the state hospital association adopted the program in 2003: After 18 months, the rate of catheter infections in ICU patients declined 66 percent. That translated into 1,729 lives and more than $236 million saved.

Maryland was not among the 14 states cited by the oversight committee. But the state does require hospitals to have infection prevention programs and, as of July, to report catheter-related, bloodstream infections in intensive care units. The Maryland Hospital Association has been a leader in education and training on this issue. A yearlong program on fighting ventilator-related pneumonia and catheter infections by the Maryland Patient Safety Center, which is funded in part by the MHA, was reported to have saved an estimated 140 lives and $140 million in costs.

Those are promising results. But Maryland and most other states don't do enough to review and assess hospital data to determine if infection-fighting programs are indeed saving lives. More follow-up needs to be done in that area.

Hospital-related infections are considered one of the top 10 causes of death by the Centers for Disease Control and Prevention. Dr. Pronovost's research has shown how simple measures can make a big difference in preventing infections. Health care workers and professionals should commit to his or similar routines. There's no acceptable excuse not to take these lifesaving steps.

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