Doctors to trial hygiene checklist prior to surgery
Safety experts have launched a new drive to improve hygiene in the NHS based on a simple checklist that has saved thousands of lives.
The scheme, called "Matching Michigan", is modelled on one pioneered in the US state where it is estimated to have saved 1,500 lives in the first 18 months. Launched in the UK on 1 May, it is being piloted in eight NHS trusts in the north east and, if successful, will be rolled out across the country.
Under the plan medical staff will be asked to run through a series of checks each time they insert a catheter into the main artery in the chest, in the same way pilots check their aircraft before take-off.
There are an estimated 200,000 "central lines" inserted each year into the aorta, the main artery leading from the heart, which carry drugs such as those used in chemotherapy for cancer that are too toxic to be administered via a vein in the arm. In around 12,400 cases (6.2 per cent) the line becomes infected, often because of poor hygiene, resulting in sepsis which can lead to severe illness and death.
The checklist contains basic reminders about hygiene – wash hands with soap, clean the patient's skin with antiseptic, cover it with sterile drapes – which every doctor and nurse knows but does not reliably carry out on each occasion. The list helps to remind staff that a single slip can cost a life. In the US, newly appointed health secretary, Kathleen Sebelius, announced this month that the checklist would be rolled out across the country with a national target to reduce central line infections by 75 per cent in three years.
Peter Pronovost, professor of critical care medicine and director of safety research at John Hopkins University, who pioneered the checklist, said: "We struggled for a couple of years [to get the idea accepted] but now it has just exploded."
Professor Pronovost is advising the UK NHS and a dozen other countries including Spain and Peru on the implementation of the scheme. He said he had been shocked to discover that hospitals in the UK did not measure their infection rates in a way that made them comparable. "I don't give a hoot how they measure them but they must do it. [Medical staff] are grossly over-confident about how good they are," he said.
High death rates from hospital infections had been tolerated for too long because the deaths were seen as inevitable, he said. "It is going to take consumer activism to tackle this. We need governments and clinicians and managers and patients behind it – without all of them in the sandbox it is not going to work."
Peter Hibbert, associate director at the National Patient Safety Agency which is running the pilot scheme in the UK, said: "We are very excited about the opportunity to reduce patient harm in this particular problem. There are lessons you can learn that can be applied to other safety issues. The health service does most things well for most patients but the checklist enables you to do it well for all patients."
The news comes months after The Independent revealed that a similar checklist for surgery is being rolled out across the NHS after a pilot in eight hospitals around the world, including St Mary's in London, showed it cut the death rate by half (from 1.5 per cent to 0.8 per cent) and the complication rate by a third (from 11 per cent to 7 per cent).
The results, published in the New England Journal of Medicine in January, showed that among the 234 million operations performed worldwide – eight million of them in Britain – there was the potential to save hundreds of thousands of lives.
The surgical checklist is backed by the World Health Organisation and includes basic questions such as Is this the right patient? Is this the right limb? Has the patient had the right drugs?
Despite their obviousness, they were not being asked and disasters were occurring as a result.
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