Hospitals Slow to Adopt Infection Prevention Program

A simple checklist could help prevent errors, even deaths, in the ICU

ByABC News
November 3, 2010, 3:18 PM

Nov. 5, 2010— -- It's a common procedure in any intensive care unit.

Doctors insert into patients what is called a central line, which can be used to administer vital medications while monitoring various critical elements within the heart and blood.

But a Centers for Disease Control and Prevention estimate shows that 250,000 patients with central lines contract blood stream infections every year, and more than 10 percent die as a result. The study, conducted in 2002, is the CDC's most current figure.

A doctor at Johns Hopkins University says these deaths can be eliminated — at virtually no extra cost and with little additional training. Moreover, a program exists that promises to do just that, but almost two years after its inception, only a fraction of hospitals choose to participate.

"In what other industry, would there be a known safety standard — and nobody's debating the evidence — that a failure to comply with kills people," Dr. Peter Pronovost, medical director for the Center for Innovation in Quality Patient Care at Johns Hopkins, told

Pronovost, a practicing anesthesiologist and critical care physician, believes these infections can be eliminated with a program he developed. But, he said, progress is too slow.

Central line catheters are nonsurgical yet invasive procedures that involve snaking a small tube into a large vein, usually in the neck, of critically ill patients.

"You don't just willy-nilly put a central line in everybody in the ICU," said Nancy Exstrom, a registered nurse and clinical educator in critical care services at St. Elizabeth Regional Medical Center in Lincoln, Neb. "But the sick ones need it and it saves their lives."

Yet the use of central lines carries the tangible risk of infection — which usually leads to extra days in the hospital and increased costs, and sometimes death.

Early last year, Pronovost set out to eliminate those infections. He created a program called On the CUSP: Stop BSI (Comprehensive Unit-Based Safety Program to reduce Central-Line Blood Stream Infections in the ICU) in concert with Johns Hopkins, the Health Research and Educational Trust (an affiliate of the American Hospital Association), and the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality.