Central line bundle including split-septum device and single-use prefilled flushing syringes to prevent port-associated bloodstream infections: a cost and resource-utilization analysis

İlker Devrim,Mustafa Taha Özkul,Neryal Tahta,Nevbahar Demiray,İlknur Çağlar,Canan Vergin,Yeliz Oruç

doi:10.1186/s12913-020-05221-6

Abstract

BackgroundCentral line bundle programs were found to be effective in decreasing central line-associated bloodstream infection rates in pediatric cancer patients with ports. However, cost-effectiveness studies of central line bundle programs in pediatric cancer patients are limited, and most available data are from intensive care unit or adult studies.MethodsIn this cross-sectional study spanning 6 years, comprehensive assessment of total health care costs attributable to CLABSI’s associated with ports between two periods.ResultsThis cross-sectional study was carried out in the pediatric hematology-oncology ward of Dr. Behçet Uz Children’s Hospital from 1 August November 2011 to 31 July 2017. The CLABSI rates decreased significantly from 8.31 CLABSIs to 3.04 per 1000 central line days (p < 0.001). In the pre-bundle period, total attributable costs spent for of patients with CLABSI were $130,661, and in the bundle period, total attributable costs spent for patients with CLABSI were $116,579. Within bundle implantation, 71 potential CLABSI were prevented, which saved an additional $208,977.ConclusionOur study shows that central line bundles decreases not only the CLABSI rate but also decreases attributable costs due to CLABSI. Expenses spent for bundle elements, were covered by savings by preventing CLABSI with higher costs.

Highlights

Central line bundle programs were found to be effective in decreasing central line-associated bloodstream infection rates in pediatric cancer patients with ports
According to our infection control committee policy, ports were the preferred route for vascular access for paediatric haematology-oncology patients and were inserted before starting induction chemotherapy under sterile conditions in the operating room
After implantation of the central line bundles, there were 41 central line-associated blood stream infections (CLABSIs) in 13,497 CL-days, which accounts for an overall rate of 3.04 CLABSIs per 1000 CL-days (Table 1)

Summary

Introduction

Central line bundle programs were found to be effective in decreasing central line-associated bloodstream infection rates in pediatric cancer patients with ports. Cost-effectiveness studies of central line bundle programs in pediatric cancer patients are limited, and most available data are from intensive care unit or adult studies. In a recent study from the United States, central line-associated blood stream infections (CLABSIs) associated with ports increased from 0.16 to 1.48 port days [2]. When they occur, they increase morbidity and mortality significantly [3, 4]. Another study from a tertiary centre in the Unites States reported an additional cost of $69,332 and an additional attributable length of stay of 21.2 days per CLABSI in paediatric haematology/oncology patients [6]. Half of the patients with CLABSI had acute lymphoblastic leukaemia or acute myelogenous leukaemia [6]

Methods

Results

Discussion

Conclusion