Infection-control checklist reduces deaths by 10%

A successful statewide intervention to prevent central line-associated bloodstream infections in intensive care units also appears to have reduced patient mortality, according to a study published in BMJ, the British medical journal.

Researchers examined Medicare data from 95 Michigan hospitals, 77% of which had implemented a checklist of infection-prevention steps as part of the "Keystone: ICU" quality improvement project. The data were compared with outcomes from hospitals in 11 other Midwestern states from 2001 to 2006. During the 22 months after the Keystone project was implemented, mortality rates dropped 10% more at hospitals in Michigan than at hospitals across the Midwest, according to the study published online Jan. 31 (link).

"We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives," said Peter J. Pronovost, MD, PhD, a study co-author and leader of the Keystone project.

The Michigan safety effort saved thousands of lives, said Dr. Pronovost, director of the Quality and Safety Research Group at the Johns Hopkins University School of Medicine in Baltimore. The Centers for Disease Control and Prevention says about 31,000 Americans die each year of central line-associated bloodstream infections, also called catheter-related bloodstream infections.

Earlier research showed that the Keystone project, coordinated by the Michigan Health & Hospital Assn. and modeled after work pioneered at Johns Hopkins Hospital, helped ICUs in Michigan cut their median central line infection rate to virtually zero per 1,000 catheter days, compared with a national average of 5.2.

Demonstrating the mortality impact of the checklist required a comparative approach, said Allison Lipitz-Snyderman, PhD, a BMJ study co-author and postdoctoral fellow in health policy at the Johns Hopkins Bloomberg School of Public Health.

"Since the intervention was not implemented in a randomized manner, it was very important to have a comparison group to see general results," Lipitz-Snyderman said. "We saw a greater reduction in mortality in Michigan areas and that supports the ideas related to this intervention, because there was no other safety intervention implemented across so many Michigan ICUs at the same time."

The infection-control achievement was due to improving hand-washing, using full-barrier precautions when inserting central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site for insertion and removing unnecessary catheters. Physicians, nurses and others were encouraged to speak up when they saw colleagues failing to follow the prevention checklist.

The Agency for Healthcare Research and Quality is funding an effort to duplicate Michigan's success in other states. Hospitals in 40 states are participating in the initiative.

"This study gives us assurance that investing in large-scale, evidence-based quality improvement programs can save lives -- the most important outcome for patients and doctors," said AHRQ Director Carolyn M. Clancy, MD.