Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: Epidemiologic and economic consequences
被引:77
作者:
Kim, James S.
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机构:
USC & LAC Med Ctr, USC Dept Infect Dis, Los Angeles, CA USAUSC & LAC Med Ctr, USC Dept Infect Dis, Los Angeles, CA USA
Kim, James S.
[1
]
Holtom, Paul
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机构:
USC & LAC Med Ctr, USC Dept Infect Dis, Los Angeles, CA USA
USC & LAC Med Ctr, USC Dept Infect Control, Los Angeles, CA USAUSC & LAC Med Ctr, USC Dept Infect Dis, Los Angeles, CA USA
Holtom, Paul
[1
,2
]
Vigen, Cheryl
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h-index: 0
机构:
Univ So Calif, Keck Sch Med, Dept Biostat, Los Angeles, CA 90033 USAUSC & LAC Med Ctr, USC Dept Infect Dis, Los Angeles, CA USA
Vigen, Cheryl
[3
]
机构:
[1] USC & LAC Med Ctr, USC Dept Infect Dis, Los Angeles, CA USA
[2] USC & LAC Med Ctr, USC Dept Infect Control, Los Angeles, CA USA
[3] Univ So Calif, Keck Sch Med, Dept Biostat, Los Angeles, CA 90033 USA
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.
机构:
Minneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Minneapolis VA Med Ctr, Med Intens Care Unit, Pulm & Crit Care Sect, Minneapolis, MN USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Bonello, Robert S.
;
Fletcher, Carol E.
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h-index: 0
机构:
Ann Arbor VA Med Ctr, Ann Arbor, MI USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Fletcher, Carol E.
;
Becker, William K.
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h-index: 0
机构:
Fargo VA Med Ctr, Fargo, ND USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Becker, William K.
;
Clutter, Kay L.
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h-index: 0
机构:
Minneapolis VA Med Ctr, Med Intens Care Unit, Minneapolis, MN USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Clutter, Kay L.
;
Arjes, Shelley L.
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h-index: 0
机构:
Minneapolis VA Med Ctr, Resp Care & Sleep Serv, Minneapolis, MN USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Arjes, Shelley L.
;
Cook, Jennifer J.
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h-index: 0
机构:
VA Midwest Hlth Care Network, Minneapolis, MN USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Cook, Jennifer J.
;
Petzel, Robert A.
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h-index: 0
机构:
VA Midwest Hlth Care Network, Minneapolis, MN USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Edwards, Jonathan R.
;
Peterson, Kelly D.
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机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Peterson, Kelly D.
;
Mu, Yi
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h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Mu, Yi
;
Banerjee, Shailendra
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h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Banerjee, Shailendra
;
Allen-Bridson, Katherine
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h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Allen-Bridson, Katherine
;
Morrell, Gloria
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h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Morrell, Gloria
;
Dudeck, Margaret A.
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h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Dudeck, Margaret A.
;
Pollock, Daniel A.
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h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Pollock, Daniel A.
;
Horan, Teresa C.
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h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
机构:
New York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USANew York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA
Galpern, David
;
Guerrero, Alejandro
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h-index: 0
机构:
New York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USANew York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA
Guerrero, Alejandro
;
Tu, Ann
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h-index: 0
机构:
New York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USANew York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA
Tu, Ann
;
Fahoum, Bashar
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h-index: 0
机构:
New York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA
Cornell Univ, Weill Med Coll, New York, NY 10021 USANew York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA
Fahoum, Bashar
;
Wise, Leslie
论文数: 0引用数: 0
h-index: 0
机构:
New York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA
Cornell Univ, Weill Med Coll, New York, NY 10021 USANew York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA
机构:
Minneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Minneapolis VA Med Ctr, Med Intens Care Unit, Pulm & Crit Care Sect, Minneapolis, MN USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Bonello, Robert S.
;
Fletcher, Carol E.
论文数: 0引用数: 0
h-index: 0
机构:
Ann Arbor VA Med Ctr, Ann Arbor, MI USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Fletcher, Carol E.
;
Becker, William K.
论文数: 0引用数: 0
h-index: 0
机构:
Fargo VA Med Ctr, Fargo, ND USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Becker, William K.
;
Clutter, Kay L.
论文数: 0引用数: 0
h-index: 0
机构:
Minneapolis VA Med Ctr, Med Intens Care Unit, Minneapolis, MN USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Clutter, Kay L.
;
Arjes, Shelley L.
论文数: 0引用数: 0
h-index: 0
机构:
Minneapolis VA Med Ctr, Resp Care & Sleep Serv, Minneapolis, MN USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Arjes, Shelley L.
;
Cook, Jennifer J.
论文数: 0引用数: 0
h-index: 0
机构:
VA Midwest Hlth Care Network, Minneapolis, MN USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
Cook, Jennifer J.
;
Petzel, Robert A.
论文数: 0引用数: 0
h-index: 0
机构:
VA Midwest Hlth Care Network, Minneapolis, MN USAMinneapolis VA Med Ctr, Med, Minneapolis, MN 55417 USA
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Edwards, Jonathan R.
;
Peterson, Kelly D.
论文数: 0引用数: 0
h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Peterson, Kelly D.
;
Mu, Yi
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h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Mu, Yi
;
Banerjee, Shailendra
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h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Banerjee, Shailendra
;
Allen-Bridson, Katherine
论文数: 0引用数: 0
h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Allen-Bridson, Katherine
;
Morrell, Gloria
论文数: 0引用数: 0
h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Morrell, Gloria
;
Dudeck, Margaret A.
论文数: 0引用数: 0
h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Dudeck, Margaret A.
;
Pollock, Daniel A.
论文数: 0引用数: 0
h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
Pollock, Daniel A.
;
Horan, Teresa C.
论文数: 0引用数: 0
h-index: 0
机构:
Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USACtr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Preparedness Detect & Control Infect Dis, Publ Hlth Serv,US Dept HHS, Atlanta, GA 30333 USA
机构:
New York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USANew York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA
Galpern, David
;
Guerrero, Alejandro
论文数: 0引用数: 0
h-index: 0
机构:
New York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USANew York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA
Guerrero, Alejandro
;
Tu, Ann
论文数: 0引用数: 0
h-index: 0
机构:
New York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USANew York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA
Tu, Ann
;
Fahoum, Bashar
论文数: 0引用数: 0
h-index: 0
机构:
New York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA
Cornell Univ, Weill Med Coll, New York, NY 10021 USANew York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA
Fahoum, Bashar
;
Wise, Leslie
论文数: 0引用数: 0
h-index: 0
机构:
New York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA
Cornell Univ, Weill Med Coll, New York, NY 10021 USANew York Methodist Hosp, Dept Surg, Brooklyn, NY 11215 USA