According to the New York Times, the fourth-leading cause of death in the United States is hospital-acquired infections (nosocomial infections). Nosocomial infections are infections, such as pneumonia, that patients contract while receiving treatment in hospitals. These infections cost the U.S. healthcare system over $40 billion every year.

Hospitals across the nation are taking steps to decrease the prevalence of nosocomial infections, making incredible progress in some areas. Yet, studies show there is still a long way to go.

Safety Checklists Prove Effective

An experiment conducted in 2003 in Michigan demonstrated the effectiveness of a simple checklist in reducing certain types of patient infections. To reduce the occurrence of central-line catheter infections, the Michigan Health and Hospital Association required 103 intensive-care units to use a five-point checklist when inserting catheters into patients. The results were incredible: the median rate of infection dropped to zero and remained at zero throughout 15 months of follow-up monitoring.

The same hospitals implemented a similar checklist method to reduce ventilator-associated pneumonia. Again, by using the checklist method, the hospitals were successful in eliminating this infection, reducing the median infection rate to zero.

Risks of Hospital-Acquired Infections

Despite the success of checklists in reducing hospital-acquired infections, there is still great room for improvement. One of the main causes of nosocomial infections is the hospital workers’ failure to wash their hands frequently enough. A study published in the American Journal of Medicine Quality revealed that most hospitals have hand-washing rates below 50 percent. The study also showed that medical personnel in intensive care units only wash their hands one quarter as often as they should.

Atul Gawande, author of The Checklist Manifesto, says implementing checklist systems in more hospitals nationwide will help improve rates of basic tasks such as hand washing. He says hospital checklists work well for several key reasons. First, lists are reminders to busy hospital personnel who may overlook a step in a routine procedure when doing many things at once. Second, lists instill a sense of responsibility among the people involved in performing a procedure; everyone is responsible for the success or failure of the procedure. Each person has the right and the duty to say something if someone is skipping a step on the checklist.

In a recent survey conducted by the Association for the Advancement of Medical Instrumentation (AAMI), clinical engineers and biomedical engineering technicians were asked to report the biggest biomedical challenges they see in their hospitals. Interfacing devices and information systems were the top challenges, but managing alarm systems and computerized IT systems were also ranked highly (#3 and #2, respectively).

The information was collected through a research survey conducted in November 2010 by Stratton Research. There were 418 responses to the survey, which was sent to more than 2,500 hospital biomedical technicians and clinical engineers. The results were published in the March/April 2011 issue of the Biomedical Instrumentation & Technology. Clinical engineers and hospital professionals discussed the findings at the recent AAMI conference held on June 27.

The top 10 biomedical challenges were:

1. Interfacing between devices and information systems
2. Maintaining computerized IT systems
3. Managing alarms
4. Maintaining and processing endoscopes
5. Broken connectors
6. Wireless management
7. Battery management
8. Problems with patient monitors
9. Problems with dialysis equipment
10. Managing the radiation dose from CT

“In terms of solutions to these challenges, clinical engineering veterans and other professionals hit the same broad themes: better education and training, stronger and communication and cooperation among departments, and often a need for standards,” stated Paul W. Kelley, CBET, of Washington Hospital Healthcare System in Fremont, Calif.

“The successful implementation of interoperability requires defined objectives and measurable goals”, noted Carol Davis-Smith, CCE, Premier Healthcare Alliance in Charlotte, N.C., “as well as a complete and well-maintained physical inventory of the applicable items included in the network.” Davis-Smith recommended prioritizing and making data-driven decisions when implementing interoperable devices.

“What we’re finding out there in the community, is that one, our basic CMO mass inventory is not clean. We need to get that cleaned up, and the reason being, because we need to have IT collect this really granular data about each of those individual devices, what can talk and what cannot talk, to what extent does it talk and how does it talk,” Davis-Smith said. “Bringing this level of granularity might be an ice-breaker in the IT department.”

Kelley said, “We learned [from the survey] that IT plays a huge role in biomedical engineering, as three of the top 10 challenges are IT-related. The IT department, clinical engineers, clinicians and vendors have to work together. Healthcare is most definitely a team sport.”

Related to interoperability, alarm management was also a strong focus of Monday’s discussion. Managing alarms has become a widespread issue—gaining media exposure with stories in The Boston Globe, The Washington Post, CBS Nightly News, and National Public Radio—as hospitals are attempting to manage the alarm fatigue caused by the countless visual and audible alarms directed at nurses each day.

“In terms of the top 10 medical device challenges, it really interacts with so many of the other challenges: interfacing, computer updates, broken connectors, patient monitors,” said J. Tobey Clark, CCE, of the University of Vermont in Burlington. “All of those other hazards directly impact clinical alarms.”

Clark said that sounds are actually just a portion of the problem. He said caregivers cannot recognize more than six different alarm sounds and have difficulty distinguishing between high- and low-priority alarms.

“This clinical alarm problem is very complex,” he said. “The stumbling block is human limitations. Because it’s a complex problem, you need a complex solution,” Clark said. “We need a multi-disciplinary approach to resolve this problem. False alarms and nuisance alarms [are] by far the biggest problems that lead to alarm fatigue.”

The issue of clinical alarm fatigue will be the focus of an upcoming AAMI summit in Herndon, Virginia, Oct. 4-5.