James S Kim1, Paul Holtom2, Cheryl Vigen3. 1. USC Department of Infectious Diseases, USC and LAC Medical Center, Los Angeles, CA. Electronic address: jskim@mednet.ucla.edu. 2. USC Department of Infectious Diseases, USC and LAC Medical Center, Los Angeles, CA; USC Department of Infection Control, USC and LAC Medical Center, Los Angeles, CA. 3. Department of Biostatistics, Keck School of Medicine, Los Angeles, CA.
Abstract
BACKGROUND: Central venous lines (CVLs) are used extensively in intensive care units (ICUs) but can sometimes lead to catheter-related blood stream infections (CRBSIs). This study evaluated a "CVL bundle" to see whether the CRBSI rate would decrease, analyze any changes in the flora of CRBSIs, and project any decrease in health care costs. METHODS: The CVL bundle was implemented on all patients admitted to the ICU starting January 2008. Data from CRBSI rates from 2006 and 2007 were pooled to compare the intervention. A Poisson analysis generated a relative risk reduction. Determination of costs were made by taking the excess length of stay multiplied by other costs (supplies, medications, cost of replacement of CVL) at our institution. RESULTS: Overall infection rates decreased with an improvement in CRBSIs in all ICUs that participated. Although the proportion of gram-negative organisms did not change significantly, there was a decrease in the proportion of gram-positive infections (P = .05) and an increase in fungal infections (P = .04). The total excess cost per organism was determined by the following: total excess cost = excess length of stay + replacement of CVL + drug administration + antibiotic cost. The weighted excess cost took the total excess cost times a correction factor based on organism frequency. The total excess cost of any given CRBSI is approximately $32,254. CONCLUSION: Preventing CRBSIs can improve patient care while reducing hospital stays, costs, and possible mortality. CVL bundles are fairly easy to perform with reproducible results.
BACKGROUND: Central venous lines (CVLs) are used extensively in intensive care units (ICUs) but can sometimes lead to catheter-related blood stream infections (CRBSIs). This study evaluated a "CVL bundle" to see whether the CRBSI rate would decrease, analyze any changes in the flora of CRBSIs, and project any decrease in health care costs. METHODS: The CVL bundle was implemented on all patients admitted to the ICU starting January 2008. Data from CRBSI rates from 2006 and 2007 were pooled to compare the intervention. A Poisson analysis generated a relative risk reduction. Determination of costs were made by taking the excess length of stay multiplied by other costs (supplies, medications, cost of replacement of CVL) at our institution. RESULTS: Overall infection rates decreased with an improvement in CRBSIs in all ICUs that participated. Although the proportion of gram-negative organisms did not change significantly, there was a decrease in the proportion of gram-positive infections (P = .05) and an increase in fungal infections (P = .04). The total excess cost per organism was determined by the following: total excess cost = excess length of stay + replacement of CVL + drug administration + antibiotic cost. The weighted excess cost took the total excess cost times a correction factor based on organism frequency. The total excess cost of any given CRBSI is approximately $32,254. CONCLUSION: Preventing CRBSIs can improve patient care while reducing hospital stays, costs, and possible mortality. CVL bundles are fairly easy to perform with reproducible results.
Authors: Marco Ripa; Laura Morata; Olga Rodríguez-Núñez; Celia Cardozo; Pedro Puerta-Alcalde; Marta Hernández-Meneses; Juan Ambrosioni; Laura Linares; Marta Bodro; Andrea Valcárcel; Climent Casals; Maria de Los Angeles Guerrero-León; Manel Almela; Carolina Garcia-Vidal; Ana Del Río; Francesc Marco; Josep Mensa; José Antonio Martínez; Alex Soriano Journal: Antimicrob Agents Chemother Date: 2018-10-24 Impact factor: 5.191
Authors: Andrew W Dick; Eli N Perencevich; Monika Pogorzelska-Maziarz; Jack Zwanziger; Elaine L Larson; Patricia W Stone Journal: Am J Infect Control Date: 2015-01 Impact factor: 2.918