US Hospitals Lacking When It Comes to Infection Protocols

Most of us don’t expect to face a life-threatening infection when we’re being treated at a hospital.

But according to a new study, the most comprehensive of its kind for the last three decades, it’s a very real possibility.

The study by researchers from the Columbia University School of Nursing in New York found that even when hospitals have policies in place to prevent infections through the use of certain healthcare equipment, clinicians often fail to follow those guidelines–even in intensive care units, where patients are often treated with devices linked to preventable infections.

Researchers studied compliance rates in 1,653 intensive care units at 975 hospitals, and focused on three of the most common preventable infections: bloodstream infections associated with central lines; ventilator-associated pneumonia; and catheter-associated urinary tract infections.

The study found that one in 10 hospitals dooesn’t have checklists in place to prevent bloodstream infections, one in four lacks checklists to prevent ventilator-related pneumonia, and for those that do have checklists, they are followed less than half the time.

“Hospitals aren’t following the rules they put in place themselves to keep patients safe,” said Patricia Stone, PhD, centennial professor of Health Policy at Columbia Nursing, and head of the study. “Rules don’t keep patients from dying unless they’re enforced.”

While more than 90 percent of the ICUs included in the study had checklists that included hand washing and dressing changes to ensure sterile insertion of central lines, only about half of those were followed, putting patients at risk for developing deadly blood infections through unsafe procedures.

For the use of ventilators, which provide oxygen when patients are unable to breathe on their own, three out of four ICUs had checklists to protect against infections, but those checklists–including elevating patients so their heads are higher than their feet to prevent pneumonia–were only followed about half the time.

About a third of hospitals had established policies to prevent against urinary tract infections from catheters, researchers said, but those policies were followed less than 30 percent of the time.

“Every hospital should see this research as a call to action–it’s just unconscionable that we’re not doing every single thing we can, every day, for every patient, to avoid preventable infections,” said Stone.

Infections associated with health care kill about 100,000 Americans a year, according to the Centers for Disease Control, and create about $13 billion in excess medical costs. Checklists and other infection control practices can improve those rates, officials say, but only if there’s compliance.

Researchers suggested the implementation of two solutions: electronic monitoring systems that provide reports cards on compliance rates; and adding more staff certified in infection control to monitor compliance.

“We’ve come a long way in understanding what causes health care-associated infections and how to prevent them,” Stone said. “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.”

The study appeared in the American Journal of Infection Control.

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