Central-line infections

The way hospitals think about central-line infections has changed in recent years, said James J. Gordon, M.D., chief of infectious diseases at Huron Valley-Sinai Hospital in Commerce, Mich. "If best practices are utilized, the vast majority of line infections can be avoided," he said. Medicare agrees: It no longer pays the extra costs associated with those infections.

The breakthrough came after years of research on effective steps in infection control, when Peter Pronovost, M.D.,Ph.D., of Johns Hopkins implemented this body of evidence in the unlikely form of a simple five-step checklist. The checklist translated the most effective known approaches into a common-sense series of precautions to follow when inserting, using, or removing a central line.

The steps require equipment no more complex than hand soap, an antiseptic solution, and sterile drapes and garb. Other key components: giving nurses the authority to make doctors follow all the steps, and measuring and reporting infection rates.

Research suggests that the checklist can cut infections linked to central lines by two thirds, and save thousands of lives and millions of dollars.

Though the checklist seems simple, it does demand time and attention in the high-pressure environment of an ICU.