Becker's Clinical Quality & Infection Control

27 INFECTION CONTROL & PATIENT SAFETY Medical Errors Are No. 3 Cause of Death in the US By Heather Punke T he CDC lists chronic respiratory dis- eases as the No. 3 cause of death in the U.S., behind heart disease and cancer, but researchers from Baltimore-based Johns Hopkins beg to differ. ey analyzed data from an eight-year period and found medi- cal errors are the true third leading cause of death in the U.S. Research published in e BMJ May 3 shows medical errors kill more than 250,000 Americans each year, while the CDC says respiratory disease kills close to 150,000 every year. To find those numbers, researchers exam- ined four separate studies analyzing medical death rate data from 2000 to 2008. ey then used hospital admission rates from 2013 and extrapolated how many deaths stemmed from medical errors. Martin Makary, MD, lead author of the study, says the discrepancy comes from the way the U.S. compiles national health statis- tics. "Our national health statistics…do not take medical care gone wrong as a cause of death," he says. ings like diagnostic errors, medication errors, communication break- downs or system errors that can lead directly to a patients' death are not counted, because national health statistics are based on ICD billing codes. While the number of medical errors is clear- ly troubling, the larger problem lies in how the statistics are calculated. "e list we gen- erate each year as a country of our national health statistics is a big deal," Dr. Makary says. "It informs our [National Institutes of Health] funding, public health campaigns and awareness efforts in the medical com- munity and the public." Because national health statistics don't recog- nize the role of medical errors, research on the problem is "vastly underfunded, and it's very difficult for patient safety and quality research- ers to get the support and funding it deserves relative to other causes of death listed in the national health statistics," says Dr. Makary. To fix the problem, Dr. Makary says the nation needs to allow physicians to branch beyond ICD codes to list the true cause of death. Additionally, physicians need to be able to discuss medical errors "without creat- ing a litigation frenzy," he says. Dr. Makary and three colleagues from Johns Hopkins also penned an open letter to omas Frieden, MD, the director of the CDC, urging him to add medical errors to the CDC's list of most common causes of death in the county to allow physicians to list medical error as a cause of death. Bob Anderson, chief of the CDC's mortality statistics branch, told NPR that medical care complications are in fact listed on death cer- tificates and captured in ICD codes, but the underlying condition is what is used in na- tional health statistics. Additionally, he said because the current way of counting causes of death aligns with international guidelines, it would be hard to change "unless we had a really compelling reason to do so." n Central Line Infection Prevention Bundle Reduces CLABSIs Among Newborns By Shannon Barnet A ustralian researchers demonstrated a central line infection prevention bundle could reduce the num- ber of central venous catheters inserted and the number of central line-associated bloodstream infections in babies in a new study published in Infection Control & Hospital Epidemiology. The retrospective cohort study was conducted in a Level 5 neonatal intensive care unit at the Royal Prince Alfred Hospital in Sydney. The bundles examined in the study encompassed the insertion of the CVC, CVC maintenance, an education program and ongoing surveillance and feedback protocols. The baseline and intervention groups were comparable in clinical characteristics, but highlighted below are three ways the outcomes of the groups differed. 1. The number of inserted CVCs was much lower in the intervention group than the baseline group, with central line utilization rates of 0.2 and 0.16, respectively. 2. Peripherally inserted CVC dwell time was also lower in the intervention group, at 6 days compared to 7.3 days. 3. CLABSIs were significantly reduced, "predominantly secondary to decreased peripherally inserted CVC-relat- ed bloodstream infections," according to the study. The intervention group had 1.2 infections per 1,000 central line-days compared to 11.5 infections per 1,000 central line-days in the baseline group. n Here Are the Conditions That Kill Most Americans, According to the CDC By Max Green T he CDC has reviewed all death certificates filed in the 50 states and Washington, D.C., in 2014 to determine the most common causes of death for Americans. The 10 leading causes of death, which accounted for 74 percent of all deaths in the U.S. in 2014 were, in rank order: 1. Cardiovascular disease 2. Cancer 3. Chronic lower respiratory diseases 4. Accidents and unintentional injuries 5. Cerebrovascular diseases 6. Alzheimer's disease 7. Diabetes mellitus 8. Influenza and pneumonia 9. Nephritis, nephritic syndrome and nephrosis 10. Intentional self-harm This order remains unchanged from 2013 data. n "Our national health statistics...do not take medical care gone wrong as a cause of death." — Dr. Martin Makary

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