“We don’t want to throw a bunch of antibiotics at people who don’t need them,” says Reston pharmacist Kevin Roshak. Would physicians have listened so closely to a pharmacist five years ago? “I don’t think so,” he says. “Pharmacy is, more and more, getting the respect of physicians. We are getting more and more involved in patient care.” Reston Hospital Center President and CEO Tim McManus agrees. “In the old days,” he says, “a pharmacist would have been stuck in a room, dispensing drugs.”
Another new tool: fighting infections from the top. “One of the things I think is incredibly important is that reports of any infections come to me,” McManus says. “That really pushes all of us to have it front and center.”
The culture change may be the biggest breakthrough in fighting hospital infections—producing a bigger effect than any new technology or even new drugs could have. “That wouldn’t have happened five years ago,” says Charlene Pennington, quality coordinator at the hospital. Top management would have known what the general infection rate was from month to month, she says, but would not have been notified about individual infections.
LOW-TECH APPROACH
Dr. Keith Dockery says that there is little reason that hospitals cannot begin putting the proven principles into effect immediately. It’s not like they need any high-tech equipment. Where he works, in the pediatric intensive-care unit at Inova Children’s, nurses keep a checklist in a loose-leaf notebook. It helps them keep track of regular chores, such as bathing each infant in chlorhexidine every day. “Otherwise, it would be easy to breeze on by,” Dockery says. The hospital is moving to an electronic format in a year, he says, but paper isn’t necessarily a bad thing. “This piece of paper here, it is easy, it is convenient,” he argues. “To do the same thing electronically, I am going to have to have 15 iPads.”
Another low-tech innovation at Children’s is a steel equipment cart loaded with the standardized kits needed to change peripheral lines and other tubes. Before, tubing was often hung near sinks or trash cans, where it could easily be splashed with germs. The steel is easy to wipe and undamaged by bleach. A generic approach like this can help target all the various germs out there, from MRSA to Clostridium difficile—a particularly nasty bug that makes spores that cannot be destroyed by alcohol-based hand sanitizer or disinfectants but must be tackled with bleach.
The Hospital Corporation of America and the National Association of Children’s Hospitals and Related Institutions are trying to spread the word about their successes. But, not surprisingly, simply telling hospitals and staff what they should do has been a miserable failure. CDC issued hand-hygiene guidelines in 2002, and infection rates stayed stubbornly high. MRSA hospitalizations more than doubled, from 127,000 in 1999 to nearly 280,000 in 2005, according to a study in the journal Emerging Infectious Diseases.
The Joint Commission on Accreditation of Healthcare Organizations issued requirements in 2003 aimed at preventing the dumbest hospital mistakes, such as getting a patient’s name wrong or amputating the wrong limb. But it wasn’t until the federal government weighed in with a stick that hospitals really started to get on board to prevent such errors. Starting in 2008, Medicare stopped paying hospitals for treating certain urinary-tract infections caused by catheters, some central-line infections, bed sores, objects left inside patients after surgery—everyone’s heard the horror stories about scissors and sponges—and falls.
Wright credits the 2010 health care law for setting the policy in stone. “In that particular piece of legislation, it was made clear that the department must tie quality outcomes to financial incentives,” he says.
Manganello sees the difference as she works in home hospice care, often treating patients who have been discharged from long-term care facilities. “Three years ago, everybody was coming out with pressure ulcers,” she said, using the technical name for bed sores. “I never see it now.”
As for Hamilton, she still takes her own precautions. “I stay out of hospitals, as best I can,” she said. “I did have to go in for a couple of days. I wiped everything down with antibacterial stuff. I made sure people washed their hands.”
This article appears in the Jan. 21, 2012, edition of National Journal.
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