Open versus closed IV infusion systems: a state based model to predict risk of catheter associated blood stream infections.
Objectives To quantify the change in risk of central line associated blood stream infection (CLABSI) following the introduction of a closed infusion container in intensive care units (ICUs) in two Latin American cities.  Design A state-space model was used to describe the flow of admissions through the ICU. This approach correctly treats infection as a time-dependent covariate.  Results A closed system reduced the risk of CLABSI. The hazard ratios for the closed versus open container were between 0.15 and 0.31 (p values<0.001), indicating a clinically significant reduction in the risk of admissions having a CLABSI. A simulation study showed that a closed system reduced the number of infections, costs and deaths.  Conclusions The data reveal costs are saved and health benefits gained from fewer cases of CLABSI after adoption of a closed infusion system. Information is required on the costs of implementing the closed system widely in these settings.
Institute of Health and Biomedical Innovation and School of Public Health, Queensland University of Technology, Brisbane, Australia.
Nicholas
N
Graves
Adrian G
AG
Barnett
Victor D
VD
Rosenthal