Rules can only serve their desired purpose if people follow them, and according to a recent Columbia University study, many hospitals fail to adhere to the very set of infection prevention rules and checklists that they’ve set for themselves — putting patients at serious risk for complications.
A review of evidence-based policies to prevent infection in 1,653 intensive care units (ICUs) at 975 hospitals nationwide has shown that preventive checklists for bloodstream infections, urinary tract infections, and pneumonia don’t meet adequate standards for safe health care, if the hospital devises such a checklist at all. With an annual cost burden of $33 billion, and 100,000 patients suffering as a result, physician oversight stands as one of the most easily preventable forms of malpractice, the researchers argue.
"Every hospital should see this research as a call to action,” said study leader and Centennial Professor of Health Policy at Columbia Nursing, Dr. Patricia Stone, in a statement. “It's just unconscionable that we're not doing every single thing we can, every day, for every patient, to avoid preventable infections.”
Stone and her team’s investigation is the first since the 1970s to critically analyze hospital infection prevention measures — around the same time the Centers for Disease Control and Prevention first linked infection rates to facilities’ lack of oversight. Since then, the majority of hospitals have implemented a system of some variety that details, explicitly, the bedside requirements for each patient, from the hospital imperative of hand washing to information on how often a patient’s catheter must be changed.
The problem is, these checklists — crafted in nine of every 10 hospitals, Stone and her team found — are followed far less often. Three out of every four ICUs had checklists to ensure patients who need a ventilator to breathe for them were receiving help to prevent pneumonia infections, but only half of those hospitals ever followed their checklists. The researchers point out keeping a patient’s head above his feet is a simple way to prevent such an infection. Also of concern were urinary catheters, which don’t come with a universal checklist and fared even worse. Less than a third of hospitals had bedside rules for preventing catheter-associated urinary tract infections (CAUTI) and among those that did, rules were followed less than 30 percent of the time.
"Hospitals aren't following the rules they put in place themselves to keep patients safe," said Stone, whose research on healthcare-associated infections has been published extensively. "Rules don't keep patients from dying unless they're enforced."
Perhaps the simplest way to make sure the rules are enforced, Stone and her team suggest, is to hire someone whose only job is to make sure hospital staff follows those rules. More than a third of hosptials in the study had no such employee on staff.
Alternatively, hospitals may take advantage of electronic monitoring systems that act as an honest broker for bedside staff, keeping tabs on which parts of the checklist have been fulfilled and which haven’t. These systems issue hospital staff “report cards” and have shown success in prior studies to increase hand washing rates, among other positive outcomes.
"We've come a long way in understanding what causes healthcare-associated infections and how to prevent them," Stone concluded. "This study shows we still have a long way to go in compliance with well-established, life-saving and cost-saving measures that we know will lower infection rates."
Source: Stone P, Pogorzelska-Maziarz M, Herzig C. State of infection prevention in US hospitals enrolled in the National Health and Safety Network. American Journal of Infection Control. 2014.