They call this irony: Maryland, where a critical-care doctor name Peter Pronovost has developed an enormously effective program for reducing life-threatening hospital infections, had the biggest increase in the rate of a common type of hospital infection among 17 states surveyed by the Centers for Disease Control and Prevention.
Between 2007 and 2009, the CDC said, Maryland had the highest rate of increase in central-line bloodstream infections, which are associated with catheters. According to Johns Hopkins researchers, about 82,000 patients a year get catheter-related infections, and 28,000 die from them. That's roughly a third of all deaths from hospital-associated infections in the United States, the CDC says.
The CDC report, released two weeks ago by its National Healthcare Safety Network, showed Maryland, worst among the 17 states surveyed, with a 30 percent increase in catheter-related infections. South Carolina (15 percent) and Tennessee (16 percent) also showed increases in central-line infections. But the remaining 14 states in the CDC's survey showed reductions, and nationally the trend was generally positive.
So Maryland, a state that boasts outstanding health care and medical research, is lagging — an irony noted by Dr. Pronovost, the Hopkins researcher who has been internationally recognized for his development of an infection-reducing protocol for doctors, nurses and other health care workers.
About nine years ago, Dr. Pronovost and his team at Hopkins developed the program, tested it out and refined it at Hopkins, then rolled it out in 100 intensive-care units at 70 Michigan hospitals. They achieved startling results. Within the first 18 months, ICU infections in the participating Michigan hospitals fell to zero, and an estimated 1,500 lives were saved. Now, more than 100 Michigan hospitals use the program, and the state's embrace of the Pronovost protocols has been held up as a model for the rest of the country.
Dr. Pronovost has received a lot of media attention for his work, and in 2008 Time named him one of its 100 most influential people in the world.
Now 40 states are adopting the Pronovost checklist, which is pretty basic: Doctors and nurses need to wash their hands with soap. They must clean a patient's skin with an antiseptic. They must put sterile drapes over the entire patient. They must have sterile masks, hats, gowns and gloves readily available in well-stocked ICU carts, and they must actually wear them. And they shouldn't leave catheters in a patient longer than necessary. (The longer one is in, the greater the chance of infection.)
Dr. Pronovost compares his checklist to the one pilots go through before they take off — except pilots are required to perform the check; doctors and nurses aren't. He also says a lot of doctors resist the checklist, and too many nurses are reluctant to challenge doctors who skip a step.
But this is lifesaving stuff, with the potential of wiping out hospital infections and saving millions in health-care costs.
Dr. Pronovost has seen his program duplicated throughout the country — except in Maryland.
Maryland, Dr. Pronovost points out in his book on patient safety, was an early disappointment in his efforts to get more states to adopt the practices that had proved effective in Michigan. A few years ago, he says, the Maryland Hospital Association expressed interest in improving patient safety but not fully implementing Dr. Pronovost's procedures, so he withdrew from the project here. "It seemed like they had a different approach and different ideas," Dr. Pronovost writes. "What bothered me most was they did not want to put resources toward supporting valid, centralized data."
And that, he says, was key to sustaining an effective attack on infections. Not only did doctors and nurses need to wash their hands; hospitals had to have accurate data to know how they were doing — and the public deserved that transparency as well. "This was especially disappointing to me because Maryland is my home state, and I care deeply about improving the patient safety there."
The good news is the state appears to be getting on board now. Carmela Coyle, in her second year as president and CEO of the Maryland Hospital Association, says hospital officials are developing the standardized data collection procedures like those in the successful Michigan system that Dr. Pronovost put in place. The latest report from the CDC, Ms. Coyle says, "keeps in front of us the need to strive to do better." That, she says, means bringing those catheter infections, and other forms of hospital-acquired infections, to zero — something that Peter Pronovost and his team proved could be achieved and even sustained.
Dan Rodricks' column appears Thursdays and Sundays in print and online, and Tuesdays online-only. His e-mail is dan.rodricks@baltsun.com. http://www.twitter.com/MiddayRodricks