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Catheter interventions reduce bloodstream infections, cut infection-related costs
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Data from a systematic review demonstrate quality improvement interventions related to central venous catheters reduced bloodstream infections by more than half and yielded significant savings for hospitals.
“About 60,400 primary bloodstream infections related to central venous catheters occur in U.S. hospitals each year, costing $1.85 billion,” Teryl K. Nuckols, MD, MSHS, of Cedars-Sinai Medical Center, Los Angeles, and RAND Corporation, and colleagues wrote. “Accordingly, hospitals are implementing various infection-prevention strategies, such as insertion checklists or bundles. Yet little is known about the economic value of doing so, meaning associated changes in clinical outcomes and costs. The program costs associated with implementing such interventions have seldom been evaluated systematically, and it is unclear whether hospitals tend to incur net savings or losses.”
Nuckols and colleagues searched Ovid MEDLINE, Econlit, Centre for Reviews & Dissemination, New York Academy of Medicine’s Grey Literature Report and Worldcat databases, as well as IDWeek conference abstracts from 2013 to 2016. They ultimately reviewed 15 studies containing data on 113 hospitals, all of which centered on interventions to prevent catheter or central-line associated bloodstream infections.
Thirteen of the studies were based in the United States, one was based in the U.K., and one in Ireland.
Interventions were associated with a 57% mean decrease in infections (incident risk ratio, 0.43; 95% CI, 0.35-0.51), Nuckols and colleagues reported. The median cost of an intervention program was $271,000 per hospital over 3 years, with hospitals saving an additional $315,000 for every $100,000 increase in intervention spending (95% CI, $166,000-$464,000). Each hospital saved $1.85 million in net incremental savings over 3 years (95% CI, $1.3 million-$2.4 million). Even in hospitals where catheter checklists were already in use, or where baseline infection rates were between 1.7 and 3.7 per 1,000 catheter days, infection rates and costs declined.
The researchers acknowledged that despite improved clinical outcomes and financial savings, spending on intervention programs might be a burden for hospitals with limited resources, and noted that the analysis did not control for hospital characteristics.
“Hospitals with ample financial resources, for example, may both invest more heavily in health care-associated infection (HAI) prevention and have better trained providers who implement interventions more effectively. Even if some hospitals can achieve greater net savings from larger, costlier HAI prevention programs, success is not assured and many hospitals may lack the cash flow or other resources to make sizeable up-front investments. Future research should more thoroughly examine the relationships among hospital financial performance, economic investments in quality improvements and effects on quality of care.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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