It started with an observation: Women in a maternity ward staffed by medical students were dying of infections at triple the rate of a similar ward staffed by midwives.
Dr. Ignaz Semmelweis made a startlingly simple deduction. The women were getting sick, he concluded, because medical students and doctors weren’t washing their hands before examining them. He ordered changes, and before long, the death rate from infections at Vienna General Hospital plummeted.
That was in 1847. Today, we take the importance of hand washing for granted. But as a report released this week reminds us, the problem of hospital-acquired infection still is with us. The new study showed that patients treated in children’s hospitals are three times more likely to develop an infection than adults in a general hospital.
Medical writer Blythe Bernhard reported in Monday’s Post-Dispatch that as many as 4 percent of the kids treated in the nation’s 38 children’s hospitals experienced an infection or other complication that extended their stay. Among the hospitals studied was St. Louis Children’s Hospital, which last week was named one of the nation’s best children’s hospitals by U.S. News & World Report.

The new study is the first to examine rates of complications and hospital-acquired infections at children’s hospitals. But there’s a vast body of literature documenting what doctors call nosocomial infections in general hospitals. About 1.7 million nosocomial infections occur in U.S. hospitals every year, and they cause an estimated 99,000 deaths.
If that surprises you, you’re not alone. We’ve come to expect medical miracles, and doctors routinely deliver them. But while hospitals have struggled to reduce nosocomial infections for years, the numbers have remained stubbornly high.
Part of the problem is the very complexity that makes modern medicine so successful. In a recent article for The New Yorker, Dr. Atul Gawande quotes a study of trauma patients that identified 1,224 different injury-related diagnoses that occurred in a mind-boggling 32,261 unique combinations. Each presents numerous opportunities for infection, complication and error. It’s a wonder that doctors — who, after all, are only human — can keep all of them straight, let alone treat them.
But in 2001, Dr. Peter Pronovost, a critical-care specialist at Johns Hopkins Hospital in Baltimore, had a startlingly simple idea. He made a checklist of five simple steps doctors could follow to avoid infections when inserting intravenous lines into patients.

Dr. Pronovost’s list contained nothing new; each step had been accepted and taught for many years. But observation showed that even the staff at Johns Hopkins, one of the nation’s best hospitals, was skipping at least one step about a third of the time they inserted those lines.
After the checklists were made part of the process, infection rates associated with the insertion of intravenous lines dropped from 11 percent to 0. Since then, similar lists have been developed for other common hospital procedures and, as unlikely as it seems, patient safety has improved at hospitals that use them.
It’s an oversimplification to suggest that making and following lists will eliminate the occurrence of nosocomial infections at children’s hospitals. In an age of expensive, high-tech solutions to complicated problems, it seems almost silly. Today’s physicians are, after all, the most thoroughly trained, best educated ever.
But then, so were the medical students at Vienna General Hospital in 1847. Hand washing didn’t eliminate maternity ward infections there; it just cut them by two-thirds.
Somewhere, Dr. Semmelweis is smiling.