Quality improvement (QI) interventions related to the use of central venous catheters (CVCs) were, on average, associated with 57% fewer infections and $1.85 million in net savings to hospitals within 1-3 years of implementation, based on the results of a meta-analysis of data from 113 hospitals.
“Hospitals that have already attained very low infection rates (through the use of quality improvement checklists) would likely see smaller clinical benefits and savings than in the studies we have reviewed,” said Dr. Teryl Nuckols of Cedars-Sinai Medical Center, Los Angeles. “Nonetheless, we found that QI interventions can be associated with declines in CLABSI (central line-associated bloodstream infection) and/or CRBSI (catheter-related bloodstream infection) and net savings when checklists are already in use, and when hospitals have CLABSI rates as low as 1.7-3.7 per 1,000 CVC-days.”
Studies were eligible for the analysis if they reported or estimated the quality improvement intervention’s clinical effectiveness, measured or modeled its costs, compared alternatives to the intervention, and reported both program and infection-related costs.
Insertion checklists were examined in 12 studies, physician education in 11 studies, ultrasound-guided placement of catheters in 3 studies, all-inclusive catheter kits in 5 studies, sterile dressings in 5 studies, chlorhexidine gluconate sponge or antimicrobial dressing in 2 studies, and antimicrobial catheters in 2 studies.
Overall, the weighted mean incidence rate ratio was 0.43 (95% confidence interval, 0.35-0.51) and incremental net savings were $1.85 million (95% CI, $1.30 million to $2.40 million) per hospital over 3 years (2015 U.S. dollars). Each $100,000 increase in program cost was associated with $315,000 greater savings (95% CI, $166 000-$464 000; P less than .001). Infections and net costs declined when hospitals already used checklists or had baseline infection rates of 1.7-3.7 per 1,000 catheter-days. (doi: 10.1001/jamainternmed.2016.6610)
Dr. Nuckols acknowledged that the price tag for achieving these savings “may be burdensome for hospitals with limited financial resources … wages and benefits account for two-thirds of all spending by hospitals, and a quarter of hospitals have had negative operating margins in recent years. We found that, for CLABSI- and CRBSI-prevention interventions, median program costs were about $270,000 per hospital over 3 years – but reached $500,000 to $750,000 in some studies.”
The researchers recommended that “future research should more thoroughly examine the relationships among hospital financial performance, economic investments in QI, and effects on quality of care.”