A checklist to prevent infection

A program that includes this checklist has been proved to prevent infections acquired in the hospital from central-line catheters, and probably helps save lives, too. But not all hospitals have adopted it. If a family member or friend has to be hospitalized in intensive care, take this list with you and ask whether the intensive-care unit uses it, says checklist developer Peter Pronovost, M.D., Ph.D., critical-care specialist and patient-safety researcher at the Johns Hopkins School of Medicine.

Caregivers should:

1. Wash their hands using soap and water or alcohol gel. Do so before and after examining the patient, inserting the catheter, and replacing, accessing, repairing, and dressing the catheter. Why it helps: It prevents bacteria from the caregiver's hands from entering the catheter directly or getting into the vein through the opening in the skin.
2. Disinfect the patient's skin. Use a 2 percent chlorhexidine-based preparation or other appropriate antiseptic before inserting the catheter and during dressing changes. Why it helps: It prevents bacteria from the patient's own skin from getting on the catheter and into the bloodstream.
3. Use full-barrier precautions. Maintain aseptic technique by wearing a mask, cap, sterile gown, and sterile gloves when inserting the catheter. The patient should be covered with a large sterile sheet. Why it helps: It prevents bacterial contamination from all sources when the catheter is being put in.
4. Avoid placing the catheter in the groin, if possible. A subclavian site is preferred because it's less likely to become infected than sites in the groin or elsewhere. Why it helps: The groin area is inherently difficult to keep clean.
5. Remove unnecessary catheters. Evaluate daily whether any catheters or tubes that are no longer essential can be removed. Why it helps: The risk of infection increases the longer the catheter is in place.