"I would have said that's ridiculous, not possible," he said. "As a physician, I was trained to believe bad things just happen."But Chase, vice president of quality at Norwegian American Hospital in Chicago, doesn't think that anymore. A growing body of research has convinced him that many infections can be prevented if proper procedures are rigorously followed -- evidence he's using to reduce higher-than-expected infection rates at his own institution.
At the same time, states are releasing data about infections in a push to hold medical institutions accountable. Recently, Illinois published information -- the first of its kind -- showing which Illinois hospitals are succeeding in controlling certain hospital-acquired infections and which are not.
Of particular concern are infections involving central lines -- large catheters that doctors place in blood vessels to deliver medications and administer fluids. About 80,000 hospital patients are infected annually in the U.S. when pathogens invade the bloodstream through the catheters, and upwards of 30,000 die.
The germs can come from a patient's skin, doctors' ties, nurses' coats, the catheter itself and various other sources.
Many Illinois hospitals have had considerable success in reducing central line-associated bloodstream infections, known as CLABSIs. The Illinois Hospital Report Card and Consumer Guide to Health Care lists 44 as having none at all in their ICUs last year.
Others didn't do as well. Thorek Memorial Hospital in Chicago had the most CLABSIs of any intensive-care unit in the state last year, at 22. Its infection rate was 13 times higher than the U.S. average.
Other facilities with high rates include Roseland Community Hospital (almost nine times higher) and St. Bernard Hospital and Health Care Center (almost six times higher), both in Chicago.
Norwegian American also is among the poor performers, a fact Chase doesn't try to sugarcoat. "We take this very seriously," he said. The hospital reported 12 CLABSIs in its medical/surgical ICU.
Dr. John Jernigan, deputy chief of prevention at the federal Centers for Disease Control and Prevention, describes the national change in approach as "a real sea change" -- a sense of hope that major improvements in care are possible.
A turning point came when Dr. Peter Pronovost, a critical care specialist from Johns Hopkins Hospital, published research in 2006 in the New England Journal of Medicine demonstrating that more than 100 intensive care units in Michigan nearly eliminated CLABSIs by following a checklist of simple procedures.
When medical staff focused vigilantly on patient safety; worked closely together; washed their hands; used gloves, masks and gowns; draped patients with coverings, and rigorously cleaned sites where catheters were inserted, among other measures, infection rates in Michigan dropped to an average rate of 1.4 for every 1,000 catheter days, from 7.7 previously.
Although CLABSIs represent only a fraction of infections that patients get in hospitals, they're "the poster child for making a difference" in medical care, Pronovost said. "We know they are measurable and largely preventable."
Hospitals across the country took notice as the Institute for Healthcare Improvement, an influential Boston-based organization, adopted Pronovost's infection-fighting strategies in its 5 Million Lives Campaign. More than 180 Illinois hospitals participated in that voluntary 2006 to 2008 effort to prevent medical harm to patients.
Among the barriers were poorly designed systems and doctors convinced that fighting infections would take time and effort they didn't have, according to Fran Griffin, an institute director.
One facility that took Pronovost's strategies to heart was Central DuPage Hospital in Winfield, which last year had one infection in its two medical/surgical ICUs, down from 19 in 2008.
After reviewing its performance, Central DuPage discovered that many central line infections occurred days after the catheter was inserted. When hospital staff instituted a dozen steps designed to maintain the sterility of the line, infections plummeted, according to Dr. David Cooke, the hospital's vice president of quality and safety.
Another was Adventist Bolingbrook Hospital, which has not had a single central line infection in its ICU since the hospital opened in January 2008. From the start, the medical center has followed Pronovost's checklist.