Be Assertive with Medical Personnel to Save Your Life

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[More on hand washing saving your life.

" Wenzel is even more assertive. He tells his own patients who have

venous catheters to say to nurses, doctors and medical

students: " Dr. Wenzel said you need to wash your hands before you

touch me or any of my catheters. " " ]

Simple Measures Reduce Bloodstream Infections

Study suggests hospitals pay attention to low-tech steps such as

hand washing

HealthDay

Wednesday, December 27, 2006

WEDNESDAY, Dec. 27 (HealthDay News) -- Every year in U.S. hospitals,

nearly 80,000 bloodstream infections result from central venous

catheters -- devices inserted through a blood vessel that ends near

or in the heart to administer medications, nutrients or other

treatments.

And about 28,000 people die annually from the infections.

Now, researchers from s Hopkins University and other facilities

have discovered that simple measures, such as hand washing, can make

a dramatic difference in reducing these infections, leaving nearly

all of them preventable.

" It's a huge problem, " said Dr. Pronovost, the study's lead

author and a professor of medicine and medical director of Hopkins'

Center for Innovation in Quality Patient Care. " In every intensive-

care unit around the country, patients every week are commonly

harmed by these infections. "

Pronovost and his colleagues used a program that had been piloted at

s Hopkins, trying it in 108 intensive-care units in Michigan,

with 103 of them reporting data. The analysis included 1,981 " ICU-

months " of data and more than 375,000 " catheter-days. " Data was

collected for up to 18 months after the safety measures were put in

place.

" We focused on improved team work, with doctors and nurses working

together, checking each other to make sure the catheter is placed

properly and that each was using equipment known to prevent

infection, like wearing a cap, " Pronovost said.

In addition, the health professionals were asked to focus on five

procedures known to reduce the infection risk. They are hand

washing; using full-barrier precautions during the insertion of the

catheters; cleaning the skin with chlorhexidine; avoiding the

femoral site (thigh bone area) if possible; and removing unneeded

catheters. The femoral artery in the groin is an area difficult to

keep sterile.

" Many doctors accepted this as a cost of doing business, " Pronovost

said, referring to the bloodstream infections. When he started the

study, he said, many of his colleagues were skeptical that the

situation could be improved much.

" What we showed was that nearly all of these [infections] are

preventable, " Pronovost said. The median rate of catheter-related

bloodstream infections per 1,000 catheter days declined from 2.7 at

the start of the trial to zero. And the mean -- or average -- rate

dropped from 7.7 at the start to 1.4 at the 16- to 18-month follow-

up.

The study is published in the Dec. 28 issue of the New England

Journal of Medicine.

Dr. P. Wenzel is chairman of the department of internal

medicine at Virginia Commonwealth University, who co-authored a

journal editorial accompanying the study. " The emphasis on protocols

and hygiene made a difference. Team work was critical, " he said of

the program, which asked doctors and nurses to check each other on

the hygiene protocols.

Dr. Jane Siegel, professor of pediatrics and an infectious-disease

specialist at the University of Texas Southwestern Medical Center at

Dallas, said: " There have been studies of this type in individual

institutions. This study was done in many hospitals, and it worked,

proving it can work on a large scale. "

The main message is intended for health-care professionals, but

consumers can take practical and usable advice from the study, the

authors and other experts concurred.

Said Siegel: " The patient or the patient advocate should be looking

to see if the health-care professional is using good hygiene,

changing the dressing, attentive to things that can be done to

reduce the risk of infections. "

Wenzel is even more assertive. He tells his own patients who have

venous catheters to say to nurses, doctors and medical

students: " Dr. Wenzel said you need to wash your hands before you

touch me or any of my catheters. "

HealthDay

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