As we mark World Antibiotic Awareness Week and European Antibiotic Awareness Day , it is vital that we do all we can to address antimicrobial resistance. The medtech sector supports a wide range of tools that reduce infection risk and support antimicrobial stewardship – some are technologically sophisticated; others are startlingly simple. Checklists are just one way that we can make surgery safer, reduce healthcare-associated infections, and support antibiotic stewardship. In 2006, Peter Pronovost, a critical care specialist at Johns Hopkins University, designed a checklist to tackle central line infections in intensive care units (ICU). On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting in a central line. Doctors are supposed to: wash their hands with soap; clean the patient's skin with chlorhexidine antiseptic; place sterilised drapes over the entire patient; wear a mask, hat, sterile gown and gloves; and put a sterile dressing over the site once the line is in. These steps are no brainers; they have been known and taught for years. So, it seemed silly to make checklist for something so obvious. Pronovost asked the nurses on his ICU to observe the doctors for a month as they put lines into patients and record how often they carried out each step. In more than one third of patients, doctors skipped at least one step. He and his team later persuaded the Johns Hopkins Hospital administration to authorise nurses to stop doctors if they saw them skipping a step on the checklist. A year afterwards, Pronovost and his colleagues monitored what happened. The results were so dramatic that they weren't sure whether to believe them: the ten-day line infection rate went from 11% to zero. So, they monitored patients for 15 more months. Only two line...
