Abstract
BackgroundIn September 2016, the Korean National Health Insurance Service began reimbursing infection control (IC) costs on condition that dedicated doctors and nurses for IC should be allocated in the hospital. We assessed the Impact of IC cost reimbursement policy on trends in central line-associated bloodstream infections (CLABSI).MethodsA before-and-after study between pre-intervention (January 2016 to February 2017) and intervention (March 2017 to December 2017) periods was performed in three intensive care units (ICU) at Daegu Fatima Hospital (a 750-bed, secondary care hospital in Daegu, Republic of Korea). The number of dedicated IC nurses increased from 2 to 5 in September 2016 and a first dedicated IC doctor was allocated in March 2017 according to the IC cost reimbursement policy. The enhanced IC team visited ICUs daily and monitor and educate the implementation of CLABSI prevention bundles. The trends between pre-intervention and intervention periods were analyzed by segmented autoregression analysis of an interrupted time series.ResultsThe average CLABSI rates and total central-line days in the pre-intervention and intervention periods were 3.41 and 2.34 per 1,000 catheter-days; 7,326 and 5,978 days, respectively. Autoregressive analysis revealed that the CLABSI rates per 1,000 catheter days per month in the pre-intervention and intervention periods were -0.256 (95% confidence interval (CI), −0.593, 0.081; P = 0.148) and −0.602 (95% CI, −0.935, −0.268; P = 0.008). The rates of compliance with maximal barrier precaution significantly improved from pre-intervention (55.1%) to intervention (89.4%) period (chi-square test, P < 0.001). The rates of compliance with maintenance bundles also significantly improved from pre-intervention (48.4%) to intervention (69.7%) period (chi-square test, P < 0.001)ConclusionThe reimbursement policy for IC cost accelerates the decline in CLABSI rates by increasing the number of IC professionals and improving monitoring, education and implementation of CLABSI prevention bundles.Disclosures All authors: No reported disclosures.
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