Did your doctor wash his or her hands before examining you?
Infections in hospitals are all too common. The environment in which a patient is trying to heal can, in fact, be a welcoming breeding ground for infection and bacteria. As a result of the complex treatment required for each patient in the intensive care unit (ICU), basic steps in patient care are sometimes skipped, even a step as obvious as the doctor washing his or her hands before examining the patient.
With more than 6,000 intensive care units in the United States, 55,000 critically ill patients are being cared for on a daily basis.
The ICU has become a place of medical magic—where patients who decades ago would have been presumed dead are hooked up to machines that take over their body’s duties and bring them back to life. There are machines that breathe for a patient, pump blood through the body, and even conduct the functions of a kidney. However, the cases that physicians and nurses handle in the ICU are increasingly complex even to a point that their mastery in the given field may no longer be adequate.
With more than 1,000 preventable deaths occurring each day in hospitals, these are issues that money alone cannot solve. All of the science and technology that was so instrumental in developing the medical equipment keeping the patients alive is no longer enough to handle the complex problems facing infections spreading in a hospital setting.
Last week, the Senate Committee on Health, Education, Labor & Pensions (HELP) Subcommittee on Primary Health and Aging held a hearing on the need to improve both patient safety and the number of preventable deaths occurring in our hospitals.
The third leading cause of death in the United States is preventable medical errors in hospitals, accounting for 440,000 deaths per year. Infections are rampant in hospitals, particularly in ICUs, with one in every twenty-five hospital patients contracting an infection in a hospital setting.
As Dr. Atul Gawande wrote in his article The Checklist,“Intensive care succeeds only when we hold the odds of doing harm low enough for the odds of doing good to prevail.” What good are the thousands of dollars being spent on machinery keeping patients alive if the patients are going to contract a fatal infection from their central line? In his book, Dr. Gawande extols the efforts and progress of Dr. Peter Pronovost, of Johns Hopkins Medicine, for his trailblazing efforts in mitigating hospital infection rates.
Dr. Peter Pronovost was one of the witnesses at this hearing.
In an attempt to curb the rate of central line infections, in 2001, Dr. Peter Pronovost created a checklist for physicians to use before inserting a line into a patient. The checklist included the following steps: (1) doctors’ hands must be washed with soap, (2) the patient’s skin must be cleaned with chlorhexidine antiseptic, (3) sterile drapes must cover the entire patient, (4) the doctor must wear a sterile mask, gown, hat, and gloves, (5) a sterile dressing must be put over the catheter site once it is in place.
The initial test-runs with the checklist were so successful that similar checklists have been written for different kinds of procedures and are being used in hospitals nationwide. The checklists would only cost about $3 million to implement nationwide, while medical errors are estimated to cost billions of dollars per year. Not only would fairly basic strategies be saving thousands of patient lives per year, but they can also save a lot of money in the process.
Despite the astounding success of the checklist, more solutions need to be formulated and implemented to decrease the number of hospital infections and the resulting preventable deaths. When patients are admitted to the hospital, they are putting their lives in the hands of the physicians and nurses caring for them. Let’s hope that those hands are washed with soap.
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