Hospital checklist cut infections, saved lives
April 8th, 2011
09:18 AM ET

Hospital checklist cut infections, saved lives

Hospitals that implemented a program including a simple, five-point checklist managed to decrease rates of an infection that kills 31,000 patients every year, according to a new study done for the federal government.

At hospitals that followed the program,  central line infections in intensive care units were reduced by 35%, according to the study. When a central line, which is a type of catheter, becomes infected, the infection can spread through the bloodstream.

A survey published Thursday of three large hospitals in the United States shows a third of patients had a mistake happen to them while being hospitalized. Most of the mistakes caused temporary harm that needed intervention, and were related to medications, procedures and infections.

The checklist reminds doctors and nurses to take basic steps, such as washing hands and cleaning a patient’s skin with the chlorhexidine antiseptic.

About 20 percent of hospitals in the United States participate in the project, which also requires that nurses be empowered to stop a procedure if the checklist is not being followed.

Dr. Peter Pronovost, medical director of the Johns Hopkins Center for Innovations in Quality Patient Care, which initiated the program, says too many doctors resist taking directions from nurses.

“If a hospital’s infection rate is high, I ask if a new nurse saw a senior doctor not comply with the checklist, would the nurse speak up and the doctor comply? The answer is uniformly no,” Pronovost told CNN in an email.

A spokesman for the American Hospital Association, which is a partner in the initiative to reduce infections, said the association has been trying to train doctors to be less resistant to nurses’ suggestions, and trying to make it easy to follow the checklist.

“If you’re seeing 50 patients a day, washing your hands 50 times a day is not as easy as you think,” said Dr. John Combes, a senior vice president of the association.

The Empowered Patient column has information on how to avoid infections in the hospital.

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soundoff (45 Responses)
  1. Susannah


    April 8, 2011 at 12:47 | Report abuse | Reply
    • Dee

      Not a nurse, but about to be a patient–and I agree completely with you!

      April 8, 2011 at 15:25 | Report abuse |
    • BethTX

      Having a checklist is the first step, but getting everyone to use it is another thing. I was a phlebotomist/QMA for a few years right out of college and I saw the nastiest things, like so-called professionals wiping bottoms, dressing wounds, and going from one patient to the other without washing their hands or wearing gloves. I even saw a doctor reach down the back of his pants to scratch his butt and then help himself to the popcorn sitting at the nurses' desk. Yuck-o!

      April 8, 2011 at 16:55 | Report abuse |
    • charles s

      "“If you’re seeing 50 patients a day, washing your hands 50 times a day is not as easy as you think,” said Dr. John Combes, a senior vice president of the association." I would disagree with this doctor. His statement indicates what mindset too many doctors have. My guess is that using a mild soap like Ivory would be sufficient to prevent the vast majority of infections. Once hands are clean, then a quick hand wash would probably be sufficient. Hands that are dirty are sticky. Bacteria secrete fluids in order to stick to surfaces. A washed hand would not allow the bacteria to stick to hand easily. A quick wash would keep the hands from becoming "sticky" and thus prevent bacteria from sticking to the hands. Bacteria do not have to be killed with antiseptics, just washed off the hands.

      Doctors have to wash their hands to stop killing their patients. It is really simple but too many doctors are too arrogant to do their job properly.

      April 10, 2011 at 22:57 | Report abuse |
  2. Pat

    After reading the Checklist Manifesto, I wouldn't go to a hospital that does not follow checklists.

    April 8, 2011 at 13:43 | Report abuse | Reply
  3. Thinking7

    I'm sure it gets annoying going from room to room washing hands, but it is a necessary thing. I took my daughter to an urgent care center a few days ago. The nurse walked in, did not wash her hands and proceeded to touch my daughter's face. Hello, Mrs. Nurse – do you think I am stupid? That is disgusting. I'm sorry if they are offended when I politely ask them to wash their hands, but hey – I am not interested in having my poor child come home with some other nasty illness because they are too lazy to wash their hands or at least wear gloves.

    April 8, 2011 at 15:02 | Report abuse | Reply
  4. jess RN

    Yeah, washing your hands 50 times is hard; but you only need to wash them if you're going to do a procedure like a central line or something sterile. Otherwise hitting the hand sanitizer on the way in and out of the room is enough to save your patients and your hands. There is no excuse for doctors to not clean up before they see a patient, not ONE excuse.

    April 8, 2011 at 15:29 | Report abuse | Reply
    • WhoKnewIt

      "but you only need to wash them if you're going to do a procedure like a central line or something sterile"....Really? Excuse me but I don't know where YOU went to nursing school but washing your hands was like day 1 and it was drummed into our heads for 4 years. And it matters not if your doing something "sterile" or not. Proper hand washing is the #1 way to help prevent the spread of germs. Please be sure to post where you work so I can tell my family and friends to steer clear of the place. What a disgusting and completely false statement!

      April 8, 2011 at 16:44 | Report abuse |
    • uainejade

      I agree with "whoknewit". There are many spored bacteria, and other types as well, which are not affected in the slightest by hand sanitizer. Washing your hands is effective and easy. You could always do both if you are especially fond of hand sanitizer.

      April 8, 2011 at 16:52 | Report abuse |
    • student RN


      You should re-read Jess RN's post, because what she is saying is true...for the majority of procedures that are not sterile, research has shown that hand Sanitizer is actually MORE effective than washing with soap and water. The current guidelines indicate that hands should be washed when visibly soiled, otherwise hand Sanitizer is preferred.

      She was not saying hands shouldn't be cleaned, just that its as easy to clean them as rubbing your hands together

      April 8, 2011 at 17:03 | Report abuse |
    • collegemom

      I agree to some extent with your assessment of the hand washing. Soap and water is required in C diff rooms and that hand hygiene is important. To all of those that don't know it hand sanitizer is more effective than soap and water on a lot of those bacteria you are talking about. Spores are mol;d and they require a lot more garb and procedure. Hospitals are not found to have molds.

      April 9, 2011 at 05:06 | Report abuse |
  5. Neal Einstein

    If washing their hands 50X is difficult for a doctor they shouldn't be doctors. A certain responsiblilty comes with the job that includes doing things which at times are difficult. Washing your hands is not all that hard. They are making excuses for making people sicker than they'd want to be. The risk of antibiotic resistant infections is rapidly increasing. We have reached a point where there are no ways to kill these newer, fully resistant mutated bacteria which spread through hospital sloppiness and lax actions such as not washing their hands inbetween visiting each patient. These doctors are committing malpractice because washing their hands is too difficult. Get another job if washing your hands is too hard to do before you see trusting patients who have put their faith in these doctors care but wind up getting sicker than when they arrived. Why? All because washing their hands is too hard for a doctor to do. Somehow they think they are above basic hygeine as well as medical school 101. The first class I ever took made a point of cleanliness over anything else. Without follow-through these disease spreading doctors are doing more harm than good. Cut the head off the snake; fire these doctors and hire some of the new interns who have already gone through the mill. Only then is there hope for recovery from the rampant disease that has caused the USA's health facilities to become well down past 50th on the list of all countries medical care. We are behind Slovenia and if washing hands would help, I would hope that my doctor, and your doctor would have firm unbreakable rules which are NOT that hard as the last sentence tries to say. One lawsuit woiuld make it very easy for any doctor who doesn't wash his hands while going on rounds to remember it each and every time from now on. Enough!

    April 8, 2011 at 16:08 | Report abuse | Reply
  6. Robbie

    I'll have my hip replacement when I call the hospital of my choice and they fax me their infection control protocols. I'll have my hip replacement when I can tour the infection control department and meet the heads of those departments. I'll have my hip replacement when 1 out of 3 people who enter the hospital aren't injured by that hospital. I'll get my hip replacement when I can call the hospital and get a written estimate of their charges.

    If I am required to be 100% responsible for my health care, dear hospital staff, you will play by my rules or you won't see a dime of my money. Not now, not ever.

    April 8, 2011 at 16:57 | Report abuse | Reply
  7. Mary A. Flowers, MD

    Baptist Hospital South in Montgomery Alabama should be shut down. The surgeons made my father's leg ischemic, perfoated his bowel putting in a catheter ; overmedicated him so he developed aspiration pneumonia , gave him anticogulants so he bled from ulcers and the nurses let him lay in his blood until he became hypotensive. When that did not kill him off they let him rot to death by neglecting him so much thtat he developed massive bedsores in the intensive care unit, develpoed bacteremia and died of septic shock. They are killing people down here and you can't sue due to recently enacted state laws which give them imunity against legal actions.. This is a license to kill set up by the same republicans who won on a Democratic platform then switched parties once they won

    April 10, 2011 at 00:40 | Report abuse | Reply
    • Shane

      You, as an MD, should have done SOMETHING to try to stop this, then.

      April 10, 2011 at 23:40 | Report abuse |
  8. Iris

    This is nothing new, and is described in great detail, and in a great read, in "The checklist manifesto" by Atul Gawande. Should be required reading for all hospital staff – especially the ones that think THEY don't need any stinkin' checklist.

    April 11, 2011 at 07:55 | Report abuse | Reply
  9. Treating impetigo

    These checklists are very good as hospitals and doctors are not free from these infections. Its really important for them to have a checklist on safety measures. Many doctors who are not serious about these safety measures spread these infections to their families. No doubt having a check list can save lots of lives.

    July 11, 2011 at 09:21 | Report abuse | Reply
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