Infection Control

Are checklists the future of infection prevention?

Briefings on Infection Control, June 1, 2009

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The adjectives ?simple? and ?effortless? are rarely associated with the healthcare industry or infection prevention. Procedures or initiatives that might seem easy often end up being complex and time-consuming. Even the simple act of hand hygiene has become a compliance headache for IPs. But a new wave of simplicity could be sweeping through the industry?and this one really is as easy as it sounds. The use of checklists dates back to World War II, when pilots used them to conduct final assessments before takeoff. Variations of those checklists are still used by pilots today. Peter Pronovost, MD, PhD, FFCM, medical director at the Center for Innovation in Quality Patient Care at Johns Hopkins Medical Center in Baltimore, decided to translate that same preflight review for use in common medical procedures, such as inserting a central-line catheter. Checklists have begun appearing in ICUs throughout the country as part of the ?ICU bundle,? a set of IC interventions specifically for the ICU, released by the Institute for Healthcare Improvement (IHI). Other checklists have been used in the surgical suite to help prevent surgeons from operating on the wrong area, or for patients on ventilators. Although checklists help improve compliance throughout many areas of the hospital, they have yet to become a staple in healthcare. Pronovost says the United States has yet to fully invest in the science of healthcare. ?We spend a penny on healthcare delivery for every dollar we spend to find new genes and to find new drugs, and some of this stuff does take investment,? Pronovost says. Initial studies In 1998, Pronovost began a four-year study at Johns Hopkins Hospital, compiling five interventions into a checklist to eliminate catheter-related bloodstream infections (CR-BSI) in the ICU. (See ?The checklist,? below.) Results of the study, which were published in the October 2004 Critical Care Medicine, showed a decrease in the CR-BSI rate from 11.3 per 1,000 catheter days to 0 per 1,000 catheter days over the course of four years. Researchers estimated that the interventions may have prevented 43 CR-BSIs, eight deaths, and $1,945,922 in additional costs per year.

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