APIC conference updates: Pronovost’s opening remarks

By: November 19th, 2009 Email This Post Print This Post

No, I’m not blogging from Washington D.C. (still from the lovely confines of my cube), but APIC has made their conference, “Healthcare-associated infections: A changing legal and regulatory landscape” a hybrid event available via webcast so that interested parties that couldn’t make the trip could still tune in.

For those of you who aren’t tuning in today, I’m posting brief updates on the sessions and some of the major takaways.

The featured speaker was Dr. Peter Pronovost, a well-known medical director at Center for Innovation in Quality Patient Care, which supports quality and safety efforts at the Johns Hopkins Hospitals. He’s also a practicing anesthesiologist and critical care physician, teacher, researcher, and international patient safety leader, with too many other titles and accomplishments for me to write out before you get bored.The most important thing you need to know is that he is responsible for the central line checklist many of you probably use for ICU patients.

Here are some of the highlights:

  • Pronovost spoke a great deal about his work developing the checklist and his studies within the state of Michigan, in which 103 hospitals saw large and sustained reductions in bloodstream infections by using the checklist and also by implementing a culture of safety.
  • He also spoke at length about the “culture of safety” where nurses would correct even senior physicians  on proper procedures during central line insertion, such as hand washing. “I went to nurses and I said, ‘When our docs are putting in catheters can you check off the list and you are empowered to stop them (if they make a mistake).’ You would have thought I caused World War III,” Pronovost said.
  • Public reporting: Pronovost indicated that public reporting will only be helpful if the parameters of the data is refined, not “squishy.” Squishy data allows for subjectivity, and as a result hospital administrations focus on looking good, rather than doing good.
  • Data: Healthcare facilities need to change data collection to make it more robust, Pronovost said. Only then will it be clear what best-practices are truly working and, more importantly, why.
  • Cooperation: Pronovost said he would like to see more healthcare facilities worry less about competition, and more about cooperation when it comes to infection prevention. In a phone interview after the conference, Pronovost pointed out that airline companies compete with each other in terms of direct flights, food, comfort, etc., however they work together when it comes to safety.
  • Reduce ambiguity: Each person on the front line of care needs to be very clear what their responsibility is to reduce infections during a particular procedure.
  • Changing the mental motto: Many believe infections, particularly bloodstream infections, are the norm rather than the exception. “We need to rethink how we are messaging that and what infections are in the inevitable bucket,” Pronovost said.
  • Giving up ownership: Pronovost stressed that IPs need to relinquish some of the infection prevention ownership to front line staff, because ultimately they are the ones who will impact reductions, and therefore should be held accountable.

He also told a story that served as a particularly interesting anecdote. In the Netherlands the government found that there were cleanliness issues in the men’s bathroom, particularly around urinals because of “men’s accuracy.” The country then conducted a randomized trial in which a fly was painted in every urinal. Amazingly, they determined “accuracy increased 80%.” It’s now public policy in the Netherlands that every urinal has a fly on it.

“It’s like its in the male genetic makeup to aim at it,” Pronovost said. “That kind of practical strategy is what we have to aim for.”

He told the story to emphasize the fact that the healthcare sector needs to search for practicality behind medical procedures that are scientifically proven to reduce infections, and then adhere to those procedures.

 

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