Atul Gawande Keynote at APIC this morning

Sat in Atul Gawande's keynote at APIC this morning. His focus was on the role of infection control, and he of course discussed in-depth the checklist movement and how it can be applied even beyond infection control. Presented his experience as he followed Brigham and Women's IP Debbie Yokoe around to see the hospital through the eyes of an infection preventionist. Some highlights from the keynote:

1. The role of an infection preventionist shouldn't be an "infection control cop". Contrasted against the Semmelweis approach of berating clinicians and providing constant reminders.

2. The people who are most careful in the operating room are often those who are the least careful outside the operating room - cited his own experience when his own patient picked up MRSA.

3. Because primary care and life expectancy is improving globally, more surgical procedures will occur, and there will be more opportunities for surgical site infections.

4. Described the checklist creation process. It is an involved process that can require up to 50 iterations before a usable checklist is developed. Goals are to create a checklist that can be executed quickly and is simple to understand. Implementing a checklist is "more than dropping a sheet of paper in the operating room."

5. Only 25% of hospitals in the US are currently using the checklist (I'm assuming he's talking about the surgery checklist). Washington state implemented it statewide and achieved reduction of infections by 25%.