Cost-effectiveness of employing a total parenteral nutrition surveillance nurse for the prevention of catheter-related bloodstream infections
Introduction
The cost of catheter-related bloodstream infection (CRBSI) is substantial in terms of the morbidity, mortality and financial resources.1, 2, 3, 4 Numerous studies have demonstrated an increase in the length of ICU stay (8–22 days) and hospitalisation (7–24 days) in patients with CRBSIs.5, 6, 7 Although such catheters provide necessary vascular access, their use puts patients at risk for local and systemic infectious complications, not only CRBSIs but also local site infection, septic thrombophlebitis, endocarditis, and other metastatic infections.8, 9, 10 The estimated number of hospital-acquired infections was 1.7 million in a national study in the USA in 2002; more than 133 000 were bloodstream infections. The estimated number of deaths associated with hospital-acquired bloodstream infections was more than 30 000.11 The attributable mortality of CRBSI (if entire hospitals are assessed) is estimated at 12–25%.12 A 10-year retrospective pairwise-matched, risk-adjusted cohort study in Belgium reported the cost attributable to CRBSI as €13,585 per patient.
Guidelines recommend educational programmes to reduce the incidence of these infections.13, 14, 15 Well-organised educational programmes that enable the healthcare worker to provide, monitor and evaluate care and to continually increase their competence are critical to the success of any strategy designed to reduce the risk of infection.13, 14, 15, 16 In recent years there has been an introduction of campaigns to increase awareness of CRBSIs and their prevention such as the 5 Million Lives and the Saving Lives Campaign.14, 17 The concept of ‘central line care bundles’ was introduced in parallel with these campaigns. Central line care bundles are a group of evidence-based interventions for patients with intravascular catheters that, when implemented together, result in better outcomes than when implemented individually.14
Total parenteral nutrition (TPN) is a recognised risk factor for CRBSI.18, 19, 20 Wang et al. performed a two-year study on 1134 patients to evaluate the risk factors for CRBSIs in patients administered with TPN.18 There was an infection rate of 11.46%; however, the results were not expressed per 1000 catheter-days. Our study is the first large study in a TPN population which expresses the decline in the rate of CRBSI per 1000 catheter-days and quantifies the economic benefit of practice change. In our hospital, a TPN multidisciplinary committee meets on a quarterly basis. In 1996 an increasing incidence of CRBSI was noted and an infection audit TPN subcommittee was introduced in 1997 based on this increase. The main objective of our study was to measure the cost-effectiveness of the reduction in CRBSIs after the introduction of TPN surveillance clinical nurse manager (CNM) and analyse the net financial benefit to the hospital.
Section snippets
Methods
This study was performed in Mater Misericordiae University Hospital, Dublin, Ireland, a 535-bed tertiary acute university hospital with a large medical and surgical gastrointestinal unit. There is a hospital-wide TPN service based at the Department of Intensive Care Medicine. In 1994 an intravenous (IV) nutrition nurse was employed, and joined a TPN multidisciplinary committee that met on a quarterly basis. The aims of the TPN multidisciplinary committee were to ensure a high standard of
Results
A total of 1932 patients received TPN and 3307 CVCs were inserted over the 15-year period, with a total of more than 20 439 CVC-days during that period. A total of 307 CRBSIs were recorded.15 Mean number of patients per year ± SD receiving TPN was 129 ± 22.43. Fifty-nine percent of patients were located on the general ward/coronary care unit, 28% of patients on the intensive care unit (ICU) and 13% of patients were located on the high dependency unit.
We compared the mean number of infections prior
Discussion
This study demonstrates the reduction in CRBSIs in TPN patients with resultant savings after the employment of a dedicated TPN surveillance CNM over a 15-year period. The establishment of a surveillance programme highlighted high rates of CRBSIs, the need for intervention and the promotion of an IV nutrition nurse to a TPN surveillance CNM. As a result, in this high risk TPN population, rates of CRBSI were reduced to 5–7 per 1000 catheter-days in recent years of our surveillance. This is
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Economic evaluations of interventions to prevent and control health-care-associated infections: a systematic review
2023, The Lancet Infectious DiseasesCatheter-related infections in patients with acute type II intestinal failure admitted to a national centre: Incidence and outcomes
2019, Clinical NutritionCitation Excerpt :Further studies have reported rates (per 1000 catheter days) of 5.1 for medical-surgical ICUs, 5.8 for trauma ICUs and 30.2 for burn units [7,9]. In the general surgical and medical ward setting, catheter-related BSI rates have also been shown to vary, with some studies reporting rates as high as 20.5 per 1000 catheter days [10–12]. ESPEN guidance on the management of chronic IF suggests that the incidence of catheter-related BSI can be used as a quality indicator of care for the patient dependent on home PN (HPN) [3].
Hospital Staffing and Health Care–Associated Infections: A Systematic Review of the Literature
2018, Joint Commission Journal on Quality and Patient SafetyCitation Excerpt :Table 1 presents the 9 studies in which the researchers examined nurse staffing and a single site–specific infection. Seven research teams examined BSI,5,17–22 1 group examined UTI,23 and the remaining study examined ventilator-associated pneumonia (VAP).24 Most of the research teams undertook data analysis at the patient level (n = 7; 77.8%), the majority in the ICU (n = 6; 66.7%).
Advanced practice nursing: Nutrition Nurse Specialist role and function
2018, Clinical Nutrition ESPENImpact of prompt catheter withdrawal and adequate antimicrobial therapy on the prognosis of hospital-acquired parenteral nutrition catheter-related bacteraemia
2014, Clinical Microbiology and InfectionCitation Excerpt :Collins et al. [2] reported an overall reduction in PN-CRBs from 33.6 cases/1000 catheter-days in 1997 to 6.8 cases/1000 catheter-days in 2008. The authors attributed these favourable results to creation of a PN support team to promote high standards in CVC insertion and care, and to regular infection audit meetings to monitor trends in CRB [24]. Current guidelines for the prevention of intravascular CRB recommend educational programmes [25], and the effectiveness of central-line care bundles has been well demonstrated [4,5,6,7].