Peter J. Pronovost is an intensive care specialist physician at Johns Hopkins Hospital in Baltimore, Maryland. He started studying hospital-acquired infections in 2001, concluding that a simple 5 item check-list protocol would greatly reduce infections when inserting a central venous catheter.
1. Wash their hands with soap.
2. Clean the patient’s skin with chlorhexidine 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.
In the Keystone Initiative, a 2003 study by a collection of Michigan hospitals and health organizations, the median rate of infections at a typical ICU dropped from 2.7 per 1,000 patients to zero after three months.
In the first three months of the project, the infection rate in Michigan’s ICUs decreased by sixty-six per cent. In the Initiative’s first eighteen months, they estimated that 1500 lives and $100 million were saved. These results were sustained for almost four years.
Several reasons may explain why a simple checklist protocol is not more widely adapted:
- Many physicians do not like being monitored by nurses or otherwise being forced to follow a checklist
- A wish to avoid standardized tasks and bureaucracy
- A focus by researchers on “more exciting” issues such as disease biology and new treatment therapies.
According to Pronovost, the fundamental problem with the quality of American medicine is that we’ve failed to view delivery of health care as a science. The tasks of medical science fall into three buckets. One is understanding disease biology. One is finding effective therapies. And one is ensuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia. It’s viewed as the art of medicine. That’s a mistake, a huge mistake. And from a taxpayer’s perspective it’s outrageous.
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