title: Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: epidemiologic and economic consequences.
abstract: 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.
  
  
  CONCLUSIONS
  Preventing CRBSIs can improve patient care while reducing hospital stays, costs, and possible mortality. CVL bundles are fairly easy to perform with reproducible results.
authors.affiliation: USC Department of Infectious Diseases, USC and LAC Medical Center, Los Angeles, CA. Electronic address: jskim@mednet.ucla.edu.
authors.forename: James S
authors.initials: JS
authors.lastname: Kim
authors.affiliation: USC Department of Infectious Diseases, USC and LAC Medical Center, Los Angeles, CA; USC Department of Infection Control, USC and LAC Medical Center, Los Angeles, CA.
authors.forename: Paul
authors.initials: P
authors.lastname: Holtom
authors.affiliation: Department of Biostatistics, Keck School of Medicine, Los Angeles, CA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Vigen
mesh_terms: D016470:Bacteremia / Q000191:economics* / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D055499:Catheter-Related Infections / Q000191:economics* / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D017048:Health Care Costs; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units / Q000191:economics; D007902:Length of Stay; D015397:Program Evaluation