title: Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy.
abstract: OBJECTIVE
  The aim was to evaluate direct health care costs of central line-associated bloodstream infections (CLABSI) and to calculate the cost-effectiveness ratio of closed fully collapsible plastic intravenous infusion containers vs. open (glass) infusion containers.
  
  
  METHODS
  A two-year, prospective case-control study was undertaken in four intensive care units in an Italian teaching hospital. Patients with CLABSI (cases) and patients without CLABSI (controls) were matched for admission departments, gender, age, and average severity of illness score. Costs were estimated according to micro-costing approach. In the cost effectiveness analysis, the cost component was assessed as the difference between production costs while effectiveness was measured by CLABSI rate (number of CLABSI per 1000 central line days) associated with the two infusion containers.
  
  
  RESULTS
  A total of 43 cases of CLABSI were compared with 97 matched controls. The mean age of cases and controls was 62.1 and 66.6 years, respectively (p = 0.143); 56% of the cases and 57% of the controls were females (p = 0.922). The mean length of stay of cases and controls was 17.41 and 8.55 days, respectively (p < 0.001). Overall, the mean total costs of patients with and without CLABSI were euro 18,241 and euro 9,087, respectively (p < 0.001). On average, the extra cost for drugs was euro 843 (p < 0.001), for supplies euro 133 (p = 0.116), for lab tests euro 171 (p < 0.001), and for specialist visits euro 15 (p = 0.019). The mean extra cost for hospital stay (overhead) was euro 7,180 (p < 0.001). The closed infusion container was a dominant strategy. It resulted in lower CLABSI rates (3.5 vs. 8.2 CLABSIs per 1000 central line days for closed vs. open infusion container) without any significant difference in total production costs. The higher acquisition cost of the closed infusion container was offset by savings incurred in other phases of production, especially waste management.
  
  
  CONCLUSIONS
  CLABSI results in considerable and significant increase in utilization of hospital resources. Use of innovative technologies such as closed infusion containers can significantly reduce the incidence of healthcare acquired infection without posing additional burden on hospital budgets.
authors.affiliation: CERGAS-Bocconi University, Via Roentgen 1, 21036 Milan, Italy. aleksandra.torbica@unibocconi.it.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Tarricone
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Torbica
authors.forename: Fabio
authors.initials: F
authors.lastname: Franzetti
authors.forename: Victor D
authors.initials: VD
authors.lastname: Rosenthal
references.citation: Infect Control Hosp Epidemiol. 2002 Apr;23(4):190-7
references.pmid: 12002233
references.citation: Hosp Formul. 1993 Jan;28 Suppl 1:51-4
references.pmid: 10123840
references.citation: J Hosp Infect. 2004 Feb;56(2):142-9
references.pmid: 15019227
references.citation: Minerva Anestesiol. 2004 May;70(5):329-37
references.pmid: 15181413
references.citation: Infect Control Hosp Epidemiol. 2006 Dec;27(12):1291-8
references.pmid: 17152025
references.citation: N Engl J Med. 2003 Mar 20;348(12):1123-33
references.pmid: 12646670
references.citation: J Hosp Infect. 2007 Jun;65 Suppl 2:3-9
references.pmid: 17540232
references.citation: Crit Care Med. 2006 Aug;34(8):2084-9
references.pmid: 16763511
references.citation: J Formos Med Assoc. 2005 May;104(5):318-26
references.pmid: 15959598
references.citation: JAMA. 1994 May 25;271(20):1598-601
references.pmid: 8182812
references.citation: J Hosp Infect. 2007 Jun;65 Suppl 2:30-3
references.pmid: 17540238
references.citation: J Chemother. 1995 Jul;7 Suppl 3:55-66
references.pmid: 8609539
references.citation: Ann Intern Med. 2000 Mar 7;132(5):391-402
references.pmid: 10691590
references.citation: Arch Surg. 2001 Feb;136(2):229-34
references.pmid: 11177147
references.citation: J Hosp Infect. 2001 Mar;47(3):198-209
references.pmid: 11247680
references.citation: J Health Serv Res Policy. 1999 Oct;4(4):255-6
references.pmid: 10623043
references.citation: Ann Intern Med. 2006 Oct 17;145(8):582-91
references.pmid: 17043340
references.citation: Am J Infect Control. 2003 Dec;31(8):475-80
references.pmid: 14647110
references.citation: Infection. 2003 Dec;31 Suppl 2:35-43
references.pmid: 15018471
references.citation: Am J Infect Control. 2004 May;32(3):135-41
references.pmid: 15153924
references.citation: N Engl J Med. 2003 Feb 13;348(7):651-6
references.pmid: 12584377
references.citation: Clin Infect Dis. 1995 Aug;21(2):403-8
references.pmid: 8562751
references.citation: Am J Infect Control. 2005 Nov;33(9):501-9
references.pmid: 16260325
references.citation: Am J Infect Control. 1991 Feb;19(1):19-35
references.pmid: 1850582
references.citation: J Hosp Infect. 2006 Jun;63(2):124-32
references.pmid: 16621137
references.citation: Epidemiol Infect. 2009 Jul;137(7):1041-8
references.pmid: 19144245
references.citation: BMJ. 1998 Oct 31;317(7167):1195-200
references.pmid: 9794854
references.citation: J Intraven Nurs. 2001 May-Jun;24(3):180-205
references.pmid: 11530364
references.citation: Am J Respir Crit Care Med. 2000 Sep;162(3 Pt 1):1027-30
references.pmid: 10988125
references.citation: J Hosp Infect. 1995 Jul;30(3):181-91
references.pmid: 8522774
references.citation: Am J Respir Crit Care Med. 2001 Jun;163(7):1584-90
references.pmid: 11401878
references.citation: Infect Control Hosp Epidemiol. 2007 Mar;28(3):280-92
references.pmid: 17326018
references.citation: Am J Respir Crit Care Med. 1999 Sep;160(3):976-81
references.pmid: 10471627
references.citation: Clin Infect Dis. 1993 Jun;16(6):778-84
references.pmid: 8329510