Hospital Infection Deaths Caused by Ignorance and Neglect

Hospital infection deaths caused by ignorance and neglect, survey finds

By N.C. Aizenman
Washington Post Staff Writer
Tuesday, July 13, 2010; A03

Deadly yet easily preventable bloodstream infections continue to plague American hospitals because facility administrators fail to commit resources and attention to the problem, according to a survey of medical professionals released Monday.

An estimated 80,000 patients per year develop catheter-related bloodstream infections, or CRBSIs -- which can occur when tubes that are inserted into a vein to monitor blood flow or deliver medication and nutrients are improperly prepared or left in longer than necessary. About 30,000 patients die as a result, according to the Centers for Disease Control and Prevention, accounting for nearly a third of annual deaths from hospital-acquired infections in the United States.

Yet evidence suggests hospital workers could all but eliminate CRBSIs by following a five-step checklist that is stunningly basic: (1) Wash hands with soap; (2) clean patient's skin with an effective antiseptic; (3) put sterile drapes over the entire patient; (4) wear a sterile mask, hat, gown and gloves; (5) put a sterile dressing over the catheter site.

The approach also calls for clinicians to continually reconsider whether the benefits of keeping the catheter in for another day outweigh the risks and to use electronic monitoring systems that allow them to spot infections quickly and assemble a rapid response team to treat them.

A federally funded program implementing these measures in intensive-care units in Michigan hospitals reduced the incidence of CRBSIs by two-thirds, saving more than 1,500 lives and $200 million in the first 18 months. Similar initiatives across the country helped bring the overall national rate of these and related bloodstream infections down by 18 percent in the first six months of 2010, according to the CDC.

"Our research shows that the cost of implementing [such programs] is about $3,000 per infection, while an infection costs between $30,000 to $36,000," said Peter Pronovost, a professor at Johns Hopkins University School of Medicine who led the program. "That means an average hospital saves $1 million."

So why aren't hospitals leaping to adopt these best practices?

The survey released Monday, which was conducted by the Association for Professionals in Infection Control and Epidemiology and funded by Bard Access Systems, a maker of catheters, pointed to ignorance and neglect at the top.

More than half of the 2,075 respondents, most of whom were infection control nurses employed by hospitals, reported that they use a cumbersome paper-based system for tracking patients' conditions that makes it harder to spot infections in real time. Seven in 10 said they are not given enough time to train other hospital workers on proper procedures. Nearly a third said enforcing best practice guidelines was their greatest challenge, and one in five said administrators were not willing to spend the necessary money to prevent CRBSIs.

Pronovost said part of the problem was that many hospital chief executives aren't even aware of their institution's bloodstream infection rates, let alone how easily they could bring them down.

When hospital leaders decide to create a culture in which preventing infections is a priority, he added, nurses feel empowered to remind physicians to follow the checklist when inserting catheters, physicians are provided antiseptic soaps as part of their catheter kits and infection control personnel have the best tools to monitor patients.

"If anyone in that chain of accountability doesn't work, you won't get your [infection] rates down," he said. "But it's the hospital's senior leadership that is ultimately responsible."

Safety Gurus: Penalize Doctors Who Don’t Follow the Rules

October 1, 2009, 3:50 PM ET
By Laura Landro

Should hospitals start penalizing doctors and nurses who fail to follow patient safety rules?

That’s one solution proposed by Peter Pronovost of Johns Hopkins and Robert Wachter of the University of California at San Francisco. Writing in the New England Journal of Medicine, the doctors contend that the failure to hold clinicians accountable for patient safety is the main reason health care is still riddled with errors, adverse events, and just plain non-adherence to some of the most basic rules.

(Compliance with hand hygiene rules ranges from 30% to 70% at most hospitals, and few have sustained rates over 80%, the authors note, while there are about 4,000 wrong-site surgeries in the U.S. annually despite a universally accepted protocol for preventing them.)

In the decade since the Institute of Medicine’s landmark “ To Err is Human” report, which estimated that up to 98,000 people a year die of medical errors, many hospitals have embraced a “no blame” model: Instead of focusing on a single individual to blame for a mistake, they’ve tried to set up systems to prevent mistakes, catch them before they cause harm, or mitigate harm from errors that do reach patients. That’s all well and good if it works, but many hospitals are now finding that a blame-free culture creates its own safety risks, Pronovost and Wachter write.

Punishments such as revoking privileges for a chunk of time tend to be used for administrative infractions that cost the hospital money – things like failing to sign the discharge summaries that insurance companies require to pay the hospital bill. By contrast, hospital administrators may just shrug their shoulders when it comes to doctors who fail or refuse to follow rules like a “time out” before surgery to avoid operating on the wrong body part.

Docs and nurses who fail to follow rules about hand hygiene or patient handoffs should lose their privileges for a week, Pronovost and Wachter suggest. They recommend loss of privileges for two weeks for surgeons who who fail to perform a “time-out” before surgery or don’t mark the surgical site to prevent wrong-site surgery.

Pronovost — best known for his development of medical checklists designed to improve patient safety — tells the Health Blog that he still sees a tremendous amount of “pushback” when he speaks to doctors. Many still resist checklists and don’t feel bound by hand washing rules, even though they’ve been shown to prevent harm to patients.

“Some of these doctors just come to the meetings to throw spears at me,” he says. “We know how important these things are for patient safety, but there needs to be some accountability for infractions,” he adds. The suggested penalties “are an attempt at a practical way to hold people accountable.”