ABSTRACT
Although Clostridium difficile (C. difficile) is the leading cause of infectious diarrhoea in hospitalized patients, the economic burden of this major nosocomial pathogen for hospitals, third-party payers and society remains unclear. We developed an economic computer simulation model to determine the costs attributable to healthcare-acquired C. difficile infection (CDI) from the hospital, third-party payer and societal perspectives. Sensitivity analyses explored the effects of varying the cost of hospitalization, C. difficile-attributable length of stay, and the probability of initial and secondary recurrences. The median cost of a case ranged from $9179 to $11 456 from the hospital perspective, $8932 to $11 679 from the third-party payor perspective, and $13 310 to $16 464 from the societal perspective. Most of the costs incurred were accrued during a patient's primary CDI episode. Hospitals with an incidence of 4.1 CDI cases per 100 000 discharges would incur costs ≥$3.2 million (hospital perspective); an incidence of 10.5 would lead to costs ≥$30.6 million. Our model suggests that the annual US economic burden of CDI would be ≥$496 million (hospital perspective), ≥$547 million (third-party payer perspective) and ≥$796 million (societal perspective). Our results show that C. difficile infection is indeed costly, not only to third-party payers and the hospital, but to society as well. These results are consistent with current literature citing C. difficile as a costly disease.
Subject(s)
Clostridioides difficile/isolation & purification , Clostridium Infections/economics , Clostridium Infections/epidemiology , Cross Infection/economics , Cross Infection/epidemiology , Health Care Costs/statistics & numerical data , Aged , Aged, 80 and over , Clostridium Infections/microbiology , Computer Simulation , Cross Infection/microbiology , Diarrhea/economics , Diarrhea/epidemiology , Diarrhea/microbiology , Humans , Incidence , Models, Statistical , United States/epidemiologyABSTRACT
Methicillin-resistant Staphylococcus aureus (MRSA) can cause severe infections in patients undergoing haemodialysis. Routine periodic testing of haemodialysis patients and attempting to decolonize those who test positive may be a strategy to prevent MRSA infections. The economic value of such a strategy has not yet been estimated. We constructed a Markov computer simulation model to evaluate the economic value of employing routine testing (agar-based or PCR) at different MRSA prevalence, spontaneous clearance, costs of decolonization and decolonization success rates, performed every 3, 6 or 12 months. The model showed periodic MRSA surveillance with either test to be cost-effective (incremental cost-effectiveness ratio ≤$50 000/quality-adjusted life-year) for all conditions tested. Agar surveillance was dominant (i.e. less costly and more effective) at an MRSA prevalence ≥10% and a decolonization success rate ≥25% for all decolonization treatment costs tested with no spontaneous clearance. PCR surveillance was dominant when the MRSA prevalence was ≥20% and decolonization success rate was ≥75% with no spontaneous clearance. Routine periodic testing and decolonization of haemodialysis patients for MRSA may be a cost-effective strategy over a wide range of MRSA prevalences, decolonization success rates, and testing intervals.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Carrier State/diagnosis , Drug Therapy/methods , Mass Screening/methods , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Renal Dialysis/adverse effects , Staphylococcal Infections/prevention & control , Aged , Aged, 80 and over , Anti-Bacterial Agents/economics , Carrier State/drug therapy , Carrier State/microbiology , Cost-Benefit Analysis , Drug Therapy/economics , Female , Humans , Male , Mass Screening/economics , Middle Aged , Models, Statistical , Staphylococcal Infections/drug therapy , Staphylococcal Infections/economics , Staphylococcal Infections/microbiology , United StatesABSTRACT
INTRODUCTION: Clostridium difficile is the most common cause of healthcare-associated infection diarrhea and usually restricted to infection of the colon. However, small bowel involvement of C. difficile infection has been reported. We performed a literature review and pooled analysis of the reported cases of C. difficile enteritis METHOD: A Pubmed literature database search and pooled analysis of the reported cases of C. difficile enteritis. RESULTS: 56 cases of C. difficile enteritis have been reported from 1980 to 2010; 48 cases were published since 2001. Median age was 55 years. 27 patients (48.2%) were female. 29 patients (51.8%) had inflammatory bowel disease (IBD) - Crohn's disease or ulcerative colitis and 20 patients (35.7%) had predisposing medical condition(s) that might lead to an immunoincompetent state. 33 patients (58.9%) had colectomy with ileostomy and 13 patients (23.2%) had other small and/or large bowel surgery. Thirty four patients (60.7%) received ICU management and 18 patients (32.1%) died. We categorized the patients into two groups, 38 survivors (67.9%) 18 non-survivors (32.1%). Significantly older age was noted in non-survivors. Median age was 48 years and 66 years, respectively for survivors and non-survivors, P < 0.001. There were more patients with predisposing medical condition(s) among non-survivors, (13/18, 72.2%) than among survivors (7/38, 18.4%), P < 0.001. CONCLUSIONS: C. difficile enteritis is still rare, however it seems to be increasingly reported in recent years. Surgically altered intestinal anatomies, advanced age, predisposing medical condition(s) that might lead to immunoincompetence appear to be at risk for developing C. difficile enteritis. Recognition of C. difficile infection not only in the colon but also in the small bowel may lead to improved outcomes.
Subject(s)
Clostridioides difficile/isolation & purification , Clostridium Infections/epidemiology , Clostridium Infections/microbiology , Enteritis/epidemiology , Enteritis/microbiology , Adult , Age Factors , Aged , Clostridium Infections/mortality , Clostridium Infections/pathology , Colectomy/adverse effects , Crohn Disease/complications , Cross Infection/epidemiology , Cross Infection/microbiology , Cross Infection/mortality , Cross Infection/pathology , Enteritis/mortality , Enteritis/pathology , Female , Humans , Ileostomy/adverse effects , Immunocompromised Host , Incidence , Intestine, Large/surgery , Male , Middle Aged , Postoperative ComplicationsABSTRACT
Although norovirus is a significant cause of nosocomial viral gastroenteritis, the economic value of hospital outbreak containment measures following identification of a norovirus case is currently unknown. We developed computer simulation models to determine the potential cost-savings from the hospital perspective of implementing the following norovirus outbreak control interventions: (i) increased hand hygiene measures, (ii) enhanced disinfection practices, (iii) patient isolation, (iv) use of protective apparel, (v) staff exclusion policies, and (vi) ward closure. Sensitivity analyses explored the impact of varying intervention efficacy, number of initial norovirus cases, the norovirus reproductive rate (R(0)), and room, ward size, and occupancy. Implementing increased hand hygiene, using protective apparel, staff exclusion policies or increased disinfection separately or in bundles provided net cost-savings, even when the intervention was only 10% effective in preventing further norovirus transmission. Patient isolation or ward closure was cost-saving only when transmission prevention efficacy was very high (≥ 90%), and their economic value decreased as the number of beds per room and the number of empty beds per ward increased. Increased hand hygiene, using protective apparel or increased disinfection practices separately or in bundles are the most cost-saving interventions for the control and containment of a norovirus outbreak.
Subject(s)
Caliciviridae Infections/prevention & control , Cross Infection/prevention & control , Disease Outbreaks , Gastroenteritis/prevention & control , Health Care Costs/statistics & numerical data , Infection Control/methods , Norovirus/isolation & purification , Caliciviridae Infections/economics , Caliciviridae Infections/virology , Computer Simulation , Cross Infection/economics , Cross Infection/virology , Gastroenteritis/economics , Gastroenteritis/virology , Health Facilities , Humans , Infection Control/economicsABSTRACT
Both bacteremia and biliary cast syndrome are serious post-transplant complications in liver transplant recipients. In the setting of increasing drug resistance in the current era, management of infections caused by multidrug-resistant (MDR) bacteria has proven challenging. We present a case of a liver transplant recipient who developed biliary cast syndrome and intractable MDR Pseudomonas bacteremia that failed to resolve with conventional antimicrobial therapy and which was finally controlled by a novel combination regimen of colistimethate, doripenem, and tobramycin. Future studies validating the clinical efficacy of this combination strategy are warranted.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Drug Resistance, Multiple, Bacterial , Liver Transplantation/adverse effects , Pseudomonas Infections/drug therapy , Pseudomonas aeruginosa/drug effects , Anti-Bacterial Agents/pharmacology , Bacteremia/microbiology , Bile Duct Diseases/drug therapy , Bile Duct Diseases/microbiology , Carbapenems/therapeutic use , Colistin/analogs & derivatives , Colistin/therapeutic use , Doripenem , Drug Therapy, Combination , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Pseudomonas Infections/microbiology , Tobramycin/therapeutic use , Treatment OutcomeABSTRACT
Over a 2-year period (2003 to 2005) patients with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) and community-acquired methicillin-susceptible Staphylococcus aureus (CA-MSSA) infections were prospectively identified. Patients infected with CA-MRSA (n = 102 patients) and CA-MSSA (n = 102 patients) had median ages of 46 and 53 years, respectively; the most common sites of infection in the two groups were skin/soft tissue (80 and 93%, respectively), respiratory tract (13 and 6%, respectively), and blood (4 and 1%, respectively). Fourteen percent of patients with CA-MRSA infections and 3% of patients with CA-MSSA infections had household contacts with similar infections (P < 0.01). Among the CA-MRSA isolates, the pulsed-field gel electrophoresis (PFGE) groups detected were USA300 (49%) and USA100 (13%), with 27 PFGE groups overall; 71% of the isolates were staphylococcal chromosome cassette mec (SCCmec) type IV, 29% were SCCmec type II, and 54% had the Panton-Valentine leucocidin (PVL) gene. Among the CA-MSSA isolates there were 33 PFGE groups, with isolates of the USA200 group comprising 11%, isolates of the USA600 group comprising 11%, isolates of the USA100 group comprising 10%, and isolates of the PVL type comprising 10%. Forty-six and 18% of the patients infected with CA-MRSA and CA-MSSA, respectively, were hospitalized (P < 0.001). Fifty percent of the patients received antibiotic therapy alone, 5% received surgery alone, 30% received antibiotics and surgery, 3% received other therapy, and 12% received no treatment. The median durations of antibiotic therapy were 12 and 10 days in the CA-MRSA- and CA-MSSA-infected patients, respectively; 48 and 56% of the patients in the two groups received adequate antimicrobial therapy, respectively (P < 0.001). The clinical success rates of the initial therapy in the two groups were 61 and 84%, respectively (P < 0.001); recurrences were more common in the CA-MRSA group (recurrences were detected in 18 and 6% of the patients in the two groups, respectively [P < 0.001]). CA-MRSA was an independent predictor of clinical failure in multivariate analysis (odds ratio, 3.4; 95% confidence interval, 1.7 to 6.9). In the community setting, the molecular characteristics of the S. aureus strains were heterogeneous. CA-MRSA infections were associated with a more adverse impact on outcome than CA-MSSA infections.
Subject(s)
Anti-Bacterial Agents , Community-Acquired Infections , Methicillin Resistance , Molecular Epidemiology , Staphylococcal Infections , Staphylococcus aureus/genetics , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/epidemiology , Bacteremia/microbiology , Case-Control Studies , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Community-Acquired Infections/microbiology , Female , Humans , Male , Methicillin/pharmacology , Microbial Sensitivity Tests , Middle Aged , Prevalence , Respiratory Tract Infections/drug therapy , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/microbiology , Risk Factors , Soft Tissue Infections/drug therapy , Soft Tissue Infections/epidemiology , Soft Tissue Infections/microbiology , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcal Infections/microbiology , Staphylococcal Skin Infections/drug therapy , Staphylococcal Skin Infections/epidemiology , Staphylococcal Skin Infections/microbiology , Staphylococcus aureus/classification , Staphylococcus aureus/drug effects , Treatment OutcomeABSTRACT
Three hundred sixty-one quinupristin-dalfopristin (Q-D)-resistant Enterococcus faecium (QDREF) isolates were isolated from humans, turkeys, chickens, swine, dairy and beef cattle from farms, chicken carcasses, and ground pork from grocery stores in the United States from 1995 to 2003. These isolates were evaluated by pulsed-field gel electrophoresis (PFGE) to determine possible commonality between QDREF isolates from human and animal sources. PCR was performed to detect the streptogramin resistance genes vatD, vatE, and vgbA and the macrolide resistance gene ermB to determine the genetic mechanism of resistance in these isolates. QDREF from humans did not have PFGE patterns similar to those from animal sources. vatE was found in 35%, 26%, and 2% of QDREF isolates from turkeys, chickens, and humans, respectively, and was not found in QDREF isolates from other sources. ermB was commonly found in QDREF isolates from all sources. Known streptogramin resistance genes were absent in the majority of isolates, suggesting the presence of other, as-yet-undetermined, mechanisms of Q-D resistance.
Subject(s)
Animals, Domestic/microbiology , Anti-Bacterial Agents/pharmacology , Drug Resistance, Bacterial/genetics , Enterococcus faecium/drug effects , Gram-Positive Bacterial Infections/microbiology , Meat/microbiology , Virginiamycin/pharmacology , Animals , Bacterial Proteins/genetics , Cattle/microbiology , Chickens/microbiology , Electrophoresis, Gel, Pulsed-Field , Enterococcus faecium/genetics , Enterococcus faecium/isolation & purification , Humans , Turkeys/microbiology , United StatesABSTRACT
BACKGROUND: Pneumonia is a major cause of morbidity and mortality in long-term care facilities. Prior studies of pneumonia have failed to identify risk factors potentially amenable to intervention. Our objectives were to (1) identify modifiable risk factors for the occurrence of pneumonia and (2) determine the long-term impact of pneumonia on survival. METHODS: We performed a case-control study among residents of a Veterans Affairs long-term care facility. Case patients included all patients developing pneumonia from 2 days to 1 year after admission. Control subjects were matched for admission date, level of nursing care, and dependence in activities of daily living. Patients were followed up for 2 years or until death or discharge from the facility. RESULTS: We identified 104 case-control pairs. Risk factors significantly associated with pneumonia included witnessed aspiration (odds ratio, 13.9; 95% confidence interval, 1.7-111.0; P =.01), sedative medication (odds ratio, 2.6; 95% confidence interval, 1.2-5.4; P =.01), and comorbidity score (odds ratio, 1.2; 95% confidence interval, 1.0-1.4; P =.05). Mortality due to pneumonia was 23% at 14 days. Patients with pneumonia had a significantly higher mortality than did controls at 1 year (75% vs 40%; P<.001); survival curves converged at 2 years. In a Cox proportional hazards regression model, an episode of pneumonia was independently associated with mortality during follow-up (odds ratio, 2.6; 95% confidence interval, 1.7-3.9; P<.001). CONCLUSIONS: Among long-term care patients closely matched for age, level of dependency, and duration of institutionalization, an episode of pneumonia is associated with significant excess mortality that persists for up to 2 years. Two identified risk factors, large-volume aspiration and receipt of sedating medication, are potentially amenable to intervention.
Subject(s)
Activities of Daily Living , Hospitals, Veterans/statistics & numerical data , Pneumonia/etiology , Pneumonia/mortality , Age Factors , Aged , Case-Control Studies , Humans , Hypnotics and Sedatives/adverse effects , Length of Stay/statistics & numerical data , Long-Term Care , Odds Ratio , Pneumonia, Aspiration/complications , Pneumonia, Aspiration/mortality , Proportional Hazards Models , Prospective Studies , Risk Factors , Survival RateABSTRACT
BACKGROUND: Enterococcus species are major nosocomial pathogens and are exhibiting vancomycin resistance with increasing frequency. Previous studies have not resolved whether vancomycin resistance is an independent risk factor for death in patients with invasive disease due to Enterococcus species or whether antibiotic therapy alters the outcome of enterococcal bacteremia. OBJECTIVE: To determine whether vancomycin resistance is an independent predictor of death in patients with enterococcal bacteremia and whether appropriate antimicrobial therapy influences outcome. DESIGN: Prospective observational study. SETTING: Four academic medical centers and a community hospital. PATIENTS: All patients with enterococcal bacteremia. MEASUREMENTS: Demographic characteristics; underlying disease; Acute Physiology and Chronic Health Evaluation (APACHE) II scores; antibiotic therapy, immunosuppression, and procedures before onset; and antibiotic therapy during the ensuing 6 weeks. The major end point was 14-day survival. RESULTS: Of 398 episodes, 60% were caused by E. faecalis and 37% were caused by E. faecium. Thirty-seven percent of isolates exhibited resistance or intermediate susceptibility to vancomycin. Twenty-two percent of E. faecium isolates showed reduced susceptibility to quinupristin-dalfopristin. Previous vancomycin use (odds ratio [OR], 5.82 [95% CI, 3.20 to 10.58]; P < 0.001), previous corticosteroid use (OR, 2.43 [CI, 1.22 to 4.86]; P = 0.01), and total APACHE II score (OR, 1.06 per unit change [CI, 1.02 to 1.10 per unit change]; P = 0.003) were associated with vancomycin-resistant enterococcal bacteremia. The mortality rate was 19% at 14 days. Hematologic malignancy (OR, 3.83 [CI, 1.56 to 9.39]; P = 0.003), vancomycin resistance (OR, 2.10 [CI, 1.14 to 3.88]; P = 0.02), and APACHE II score (OR, 1.10 per unit change [CI, 1.05 to 1.14 per unit change]; P < 0.001) were associated with 14-day mortality. Among patients with monomicrobial enterococcal bacteremia, receipt of effective antimicrobial therapy within 48 hours independently predicted survival (OR for death, 0.21 [CI, 0.06 to 0.80]; P = 0.02). CONCLUSIONS: Vancomycin resistance is an independent predictor of death from enterococcal bacteremia. Early, effective antimicrobial therapy is associated with a significant improvement in survival.
Subject(s)
Bacteremia/microbiology , Bacteremia/mortality , Enterococcus/drug effects , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/mortality , Vancomycin Resistance , APACHE , Adult , Bacteremia/drug therapy , Female , Gram-Positive Bacterial Infections/drug therapy , Humans , Male , Middle Aged , Prospective Studies , Statistics as Topic , Treatment OutcomeABSTRACT
We report an outbreak of infection due to genotypically identical extended-spectrum beta-lactamase--producing Escherichia coli among patients in a liver transplantation unit. Control of the outbreak was achieved by a combination of contact isolation, feedback on hand hygiene, and gut decontamination with an orally administered fluoroquinolone. These interventions led to abrupt curtailment of the outbreak.
Subject(s)
Disease Outbreaks , Escherichia coli Infections/microbiology , Escherichia coli/enzymology , Infection Control/methods , Liver Transplantation , beta-Lactamases/metabolism , Escherichia coli Infections/epidemiology , Escherichia coli Infections/prevention & control , Hospital Units , HumansSubject(s)
Ceftazidime/pharmacology , Ceftriaxone/pharmacology , Cephalosporin Resistance , Cephalosporins/pharmacology , Cross Infection/epidemiology , Gram-Negative Bacteria/drug effects , Nursing Homes/statistics & numerical data , Cross Infection/microbiology , Microbial Sensitivity Tests , United States/epidemiology , United States Department of Veterans AffairsABSTRACT
Establishing a clinical diagnosis of infection in residents of long-term-care facilities (LTCFs) is difficult. As a result, deciding when to initiate antibiotics can be particularly challenging. This article describes the establishment of minimum criteria for the initiation of antibiotics in residents of LTCFs. Experts in this area were invited to participate in a consensus conference. Using a modified delphi approach, a questionnaire and selected relevant articles were sent to participants who were asked to rank individual signs and symptoms with respect to their relative importance. Using the results of the weighting by participants, a modification of the nominal group process was used to achieve consensus. Criteria for initiating antibiotics for skin and soft-tissue infections, respiratory infections, urinary infections, and fever where the focus of infection is unknown were developed.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Communicable Diseases/drug therapy , Drug Utilization/standards , Residential Facilities/standards , Aged , Centers for Disease Control and Prevention, U.S. , Drug Resistance, Microbial , Fever/drug therapy , Hospitals, Chronic Disease/standards , Hospitals, Veterans/standards , Humans , Nursing Homes/standards , Practice Guidelines as Topic , Respiratory Tract Infections/drug therapy , Skin Diseases, Infectious/drug therapy , United States , Urinary Tract Infections/drug therapyABSTRACT
The incidence of pneumonia among patients in long-term care facilities is approximately 1/1000 patient-days. Evidence indicates that the majority can be managed without transfer to a hospital. Immunization with pneumococcal and influenza vaccines is appropriate for all residents.
Subject(s)
Homes for the Aged , Nursing Homes , Pneumonia/prevention & control , Aged , Algorithms , Humans , Influenza Vaccines , Pneumonia/diagnosis , Pneumonia/drug therapy , Pneumonia/microbiology , Pneumonia/mortality , Risk Factors , United States/epidemiologyABSTRACT
OBJECTIVES: To determine whether a newly-constructed long-term care facility would become colonized with Legionella and whether Legionnaires' disease would occur in residents of this new facility. DESIGN: Prospective environmental surveillance of the hospital's water distribution system for the presence of Legionella pneumophila during construction. Utilization of diagnostic tests for Legionnaires' disease in cases of nosocomial pneumonia. SETTING: The Pittsburgh VA Health Care System, Aspinwall Division, a two-building 400-bed complex. PARTICIPANTS: Six patients who acquired Legionnaires' disease while in the facility. INTERVENTION: Installation of copper-silver ionization systems. MEASUREMENTS: Isolation of L. pneumophila from potable water and the occurrence of Legionnaires' disease. RESULTS: L. pneumophila serogroup 1 was recovered from the water distribution system within 1 month of operation; 74% (61/82) of distal sites were positive during construction. In the first 2 years of occupancy, six cases of legionellosis were diagnosed. Both clinical isolates of L. pneumophila were identical to environmental isolates by pulsed field gel electrophoresis (PFGE). Copper-silver ionization systems were installed to control Legionella in the water system. CONCLUSIONS: We conclude that long-term care residents are at risk for acquiring nosocomial Legionnaires' disease in the presence of a colonized water system, even in a newly constructed building.
Subject(s)
Cross Infection/etiology , Facility Design and Construction , Legionnaires' Disease/etiology , Skilled Nursing Facilities , Aged , Aged, 80 and over , Cross Infection/diagnosis , Cross Infection/mortality , Cross Infection/prevention & control , Electrophoresis, Gel, Pulsed-Field , Enzyme-Linked Immunosorbent Assay , Humans , Infection Control , Legionella pneumophila/classification , Legionella pneumophila/isolation & purification , Legionnaires' Disease/diagnosis , Legionnaires' Disease/mortality , Legionnaires' Disease/prevention & control , Pennsylvania , Prospective Studies , Risk Factors , Serotyping , United States , United States Department of Veterans Affairs , Water Microbiology , Water Purification/methodsSubject(s)
Cross Infection/epidemiology , Legionella/isolation & purification , Legionnaires' Disease/epidemiology , Organ Transplantation , Postoperative Complications/microbiology , Cross Infection/microbiology , Cross Infection/prevention & control , Humans , Infection Control/methods , Legionnaires' Disease/diagnosis , Legionnaires' Disease/microbiology , Water SupplyABSTRACT
To determine the proportion of methicillin-resistant Staphylococcus aureus (MRSA) among patients presenting for hospitalization and to assess risk factors for MRSA carriage, we conducted a study for 13 months at five Pittsburgh-area hospitals. Of 504 S aureus identified, 125 (25%) were MRSA. Independent risk factors for MRSA included organ transplantation, employment in a healthcare facility, pressure sores, tube feeding, and hospitalization within the preceding year.
Subject(s)
Carrier State/microbiology , Cross Infection/microbiology , Methicillin Resistance , Staphylococcal Infections/microbiology , Staphylococcus aureus/isolation & purification , Community-Acquired Infections/microbiology , Hospitals , Humans , Pennsylvania , Prospective Studies , Risk Factors , Statistics as TopicABSTRACT
Because of high incidence of catheter-related urinary tract infections (UTIs) in our Veterans Affairs medical center, we began providing nursing staff with unit-specific UTI rates. In our preintervention period, the first quarter of 1995, 38 infections occurred in 1186 catheter-patient-days or 32/1000 catheter-patient-days (95% CI, 22.9-43.7). Thereafter, nursing staff members were provided with a quarterly report with catheter-related UTI rates depicted graphically by unit. In the 18 months after this intervention, the mean UTI rate decreased to 17.4/1000 catheter-patient-days (95% CI, 14.6-20.6, P =.002). We estimated a cost savings of $403,000. We conclude that unit-specific feedback of nosocomial UTI rates to nursing staff is a highly effective method of reducing infection rates and reducing costs associated with nosocomial UTI.
Subject(s)
Cross Infection/prevention & control , Feedback , Nursing Staff, Hospital , Urinary Catheterization/adverse effects , Urinary Tract Infections/etiology , Urinary Tract Infections/prevention & control , Cross Infection/etiology , Hospitals, Veterans , Humans , Practice Guidelines as Topic , Urinary Tract Infections/economicsABSTRACT
OBJECTIVE: To determine the influence of catheter site and type (single- vs triple-lumen) on infection rates associated with central venous catheterization. DESIGN: Prospective observational study of all nontunneled central venous catheters over a 28-month period. Data collected included patient characteristics, insertion site, catheter type, and receipt of parenteral nutrition. End points were clinical infection (bacteremia or site infection) and catheter contamination (clinical infection or colonization with >15 colonies on semiquantitative culture). SETTING: Medical-surgical wards of Veterans' Affairs hospital. RESULTS: Three hundred catheters were inserted into 204 patients. Seventy percent were inserted into upper-body sites, and 30% were inserted into the femoral vein. Forty-five percent were triple-lumen catheters. Bacteremia occurred in 2.7% of catheter insertions; insertion-site infections developed in 1.3%, and catheter colonization developed in 12%. Catheter contamination was associated with emergent insertion (odds ratio [OR], 6.2; 95% confidence interval [CI95], 1.1-36.7; P=.04) by logistic regression and with femoral location (hazard, 4.2; CI95, 2.0-8.8; P=.0001) and history of transplantation (hazard, 2.8; CI95, 1.1-6.7; P=.024) by Cox regression. Clinical infection was not associated with any of the risk factors evaluated, although there was a trend for association with femoral location by Cox regression (hazard, 4.7; CI95, 0.82-26; P=.08). We did not identify an association between infection and use of triple-lumen catheters or parenteral nutrition. CONCLUSION: Our data support an association between intravenous catheter contamination and insertion at a femoral site.