Blue Ribbon Abstract Award: Cost effectiveness of switching from an open IV infusion system to a closed system on rates of central venous catheter-associated bloodstream infection in three Mexican hospitals

Abstract

BACKGROUND: We ascertained the cost effectiveness of switching from an open infusion system to a closed system, with the accompanying reduction of central vascular catheter (CVC)–associated bloodstream infection (BSI) in four intensive care units (ICUs) of three Mexican hospitals. METHODS: A prospective time-series cohort trial was undertaken in adult patients admitted to four level-III ICUs, who had a CVC in place for at least 24 hours. Rates and cost of CVC-associated BSI during a period of active surveillance with an open system (baseline; externally-vented bottles) were compared to rates and cost after switching to a closed system (non-vented collapsible plastic bags). RESULTS: Between September 2002 and November 2003, 1164 ICU patients with CVCs were enrolled. Patients during each study phase were similar with respect to gender, underlying disease, severity-of-illness score, and central venous catheter longevity. Compliance with CVC care was similar during the two study phases. Handwashing compliance was above 75%, and the presence of an occlusive sterile catheter dressing was above 98% during both phases of the study. There was a total of 4584 CVC days during phase one and 3995 CVC days during phase two. The rate of CVC-associated BSI (laboratory-confirmed bloodstream infection, or LCBI, and clinical sepsis, or CSEP) during phase one was higher than during phase two (16.97 versus 3.00 BSIs per 1000 CVC-days, RR = 0.18, 95% CI = 0.10-0.32, p=0.0000). In a previous study we quantified the attributable extra costs of CVC-associated BSI in the same ICUs. CVC-associated BSIs extended ICU average length of stay by 6.05 days and resulted in added ICU costs of $6899 per patient. With a baseline CVC-associated BSI rate of 16.97 per 1000 CVC-days, 67 BSIs would have been expected to occur during the 3995 line-days over 21 ICU-months of phase two. During this time using the closed system, we documented 12 BSIs instead of 67, a reduction of 55 BSIs. This resulted in a reduction of 332.75 ICU days and a calculated cost savings during the 21 ICU-month intervention period of $379,445. This corresponds to 15.84 days and $18,069 saved per ICU per month, or a saving of 190 days and $216,826 per ICU per year. CONCLUSION: Adoption of a closed infusion system in four ICUs of three Mexican hospitals resulted in significant reduction in BSI rates and costs, with a savings of 190 ICU days and $216,826 per ICU per year.