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Greg Webb
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Checklists Lower Hospital ICU Infection Rates

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Hospital-acquired infections originating from tubes and catheters inserted into the body have long been accepted as the norm in intensive care units. These infections include ventilator-associated pneumonia, related to a tube lodged in the windpipe to assist in breathing, urinary tract infections, related to a catheter inserted into the bladder to drain the urine, and bloodstream infection, related to a catheter threaded in the veins reaching the upper chamber of the heart.

For years hospital staff have believed infections were the price patients had to pay for intensive care. At one hospital, for every 1,000 “device days” (for example, 100 ICU patients using a device for 10 days), seven patients would get pneumonia, six would get blood infections and four would get a urine infection. But, staff thought, there were antibiotics to combat the infections, and the insurance company would pay for the nearly $25,000 extra in hospital bills. Moreover, without the devices, many patients would have died.

The Institute for Healthcare Improvement, a nonprofit founded by Harvard pediatrician Donald Berwick, is trying to change those thoughts. The IHI is a nationwide effort to reduce medical errors, standardize treatments, cut waste and bring patient-centered medical care to the bedside. About 4,000 hospitals have participated in the programs.

One major component of the Institute’s plans are checklists for every patient, which have become known as “bundles:” a “ventilator bundle” for patients on a ventilator, “UTI bundle” for patients with urinary catheters, and a “central line bundle” for those with central lines. There is even a bundle for doctors, requiring them to wear a sterile gown, mask and gloves before placing a central line.

While these checklists may include what should be routine behavior from doctors and nurses, routine procedures are typically never followed 100 percent. Without these written guides set by the IHI, checklists are expected to be followed by memory, which is unrealistic.

At the hospital mentioned above, implementing the checklists caused a 50 percent decline in ICU infection rates and a 21 percent reduction in cost per ICU discharge. Where some staff had been skeptical about the initiative to reduce infection rates, simple checklists caused the hospital’s culture of patient safety and quality to change for the better.