Lawmaker: Simple Checklist Can Help Save Lives At Hospitals

Rockland County Legislature Chairwoman Harriet Cornell has sent a letter to the New York State Commissioner of Health Richard F. Daines calling upon him to enact a statewide policy that could greatly reduce, if not eradicate, all hospital-acquired infections in New York.

The policy calls for hospitals to use the Pronovost Checklist, a set of five, standardized protocols developed in 2002 by Peter Pronovost, a Johns Hopkins professor of anesthesiology and critical care medicine.

"The checklist is so easy to implement and so cost-effective that it's a bit of a wonder it hasn't already been implemented nationwide," said Cornell, D-West Nyack.

The Centers for Disease Control and Prevention (CDC) estimated that in 2002, there were 1.7 million health care-associated infections nationally, resulting in 99,000 deaths. A recent CDC report estimated that the annual costs of these infections cost U.S. hospitals between $28 billion and $45 billion.

In 2005, New York passed Public Health Law 2189, which requires the collection and publication of all hospital-acquired infections data statewide. The initial report was released in 2008 and contained 2007 data, and the second report, released in June of 2009, indicated that compared to national estimates, New York hospitals have lower rates of surgical-site infections but the same or higher rates of central line-associated bloodstream infections in intensive care units.

Cornell said that, based on the 2008 report, the two hospitals in Rockland County, Nyack Hospital and Good Samaritan in Suffern, were above the state average in some infections but below the state average in others.

"But all infection rates in Rockland County hospitals and across the state could feasibly be zero," said  Cornell. "Enter the Pronovost List."

In the 1930s, bomber pilots reduced their crash rates to zero once they began using a to-do list before takeoff. Borrowing from that idea, Peter Pronovost established his own to-do list that reminds doctors to do five simple things: wash their hands; clean a patient's skin with chlorhexidine; put sterile drapes over the patient; wear a mask, hat, gown and gloves; and place a sterile dressing over the site of a catheter once the line is in.

In her letter to  Daines,  Cornell said, "All of these steps seem so basic as to be a given, but in the hustle to save a life on the operating table or in intensive care, it can be easy to forget to perform something so crucial as washing one's hands."

Pronovost took the idea of his list to his own hospital where he conducted a fifteen-month study. During that time, the checklist prevented 43 infections and eight deaths, and it saved the health care system $2 million in costs. A hospital association in Michigan was so impressed by the statistics that it brought the checklist model to 100 intensive care units in 70 Michigan hospitals. In the first 18 months, it saved an estimated 1,500 lives and $75 million. Pronovost claims that he could do nationally what he did in Michigan for $3 million.

"If it costs only $3 million for the entire country to implement this checklist,"  Cornell said, "think how little it would cost to do it just in New York. And given how much Michigan saved in lives and money in just 18 months, it makes so much sense for all hospitals in our state to use these checklists as soon as possible."

Cornell was confirmed in her beliefs with the recent release of the Niagara Health Quality Coalition's 2010 Hospital Report Card, which revealed that while hospitals across the state have shown improvement in eight out of 10 measures of hospital error rates, hospital-acquired infection rates have not gotten better.

"It's time to improve those rates," Cornell said, "and we have the means to do so."