Effects of Maximal Sterile Barrier Precaution on the Central Venous Catheter-related Infection and Cost

중심정맥관 삽입시 최대멸균 차단법이 중심정맥관 관련 감염률과 비용에 미치는 효과

  • Lim, Jung-Hye (College of Nursing, Catholic University of Seoul) ;
  • Kim, Nam-Cho (College of Nursing, Catholic University of Seoul)
  • Received : 2010.02.18
  • Accepted : 2010.04.06
  • Published : 2010.06.30

Abstract

Purpose: The purpose of this study was to examine the effect of maximal sterile barrier precaution on the central venous catheter-related infection and subsequent cost savings. Methods: Study subjects were 462 hospitalized patients with central venous, catheter of more than 48 hours duration. Data collection period was from April 2008 to February 2009 at a tertiary university hospital in Seoul. Subjects were randomly assigned to either the treatment or the usual care group. Patients in the treatment group (n=209) were treated by staff using maximal sterile barrier precautions and the comparison group(n=253) received traditional care. Results: Central venous catheter-days was2,821 in treatment group and 3,515 in comparison group. The incidence density of central venous catheter-related infection was 2.1 times higher in the comparison group (8.2 per 1,000 catheter-days) compared with the treatment group (3.9 per 1,000 catheter-days). The incidence density of central venous catheter-related bloodstream infection was 4.54 times higher than in the comparison group (3.2 per 1,000 catheter-days) compared with the treatment group (0.7 per 1,000 catheter-days). The attributable cost of central venous catheter-related infection in the treatment group was 10,174,197 won and that of the comparison group was 22,224,554 won. Attributable cost by area was also significantly lower compared with that of the comparisons. Conclusion: The maximal sterile barrier precaution during central venous catheter insertion was an effective intervention to reduce central venous catheter-related infection rate and provides a significant cost savings.

Keywords

References

  1. Bonello, R. S., Fletcher, C. E., Becker, W. K., Clutter, K. L., Arjes, S. L., Cook, J . J ., et al. (2008). An intensive care unit quality improvement collaborative in nine departments of veterans affairs hospitals: Reducing ventilator-associated pneumonia and catheter-related bloodstream infection rates. The J oint Commission J ournal on Quality and Patient Safety, 34(11), 639-645.
  2. Carrer, S., Bocchi, A., Bortolotti, M., Braga, N., Gilli, G., Candini, M., et al. (2005). Effect of different sterile barrier precautions and central venous catheter dressing on the skin colonization around the insertion site. Minerva Anestesiologica, 71(5), 197-206.
  3. Centers for Disease Control and Prevention. (2008, March).Guidelines for the prevention of intravascular catheterrelated infections. Retrieved March 1, 2008, from http:// www.cdc.gov/nmwr/preview/mmwrhtml/rr5110al.htm.
  4. Choi, K. O., & Kim, N. C. (2009). Effects of infection control strategies for vancomycin resistant enterococci in intensive care units. Journal of Korean Academy of Adult Nursing, 21(4), 435-445.
  5. Eggimann, P., Harbarth, S., Constantin, M. N., Touveneau, S., Chevrolet, J . C., & Pittet, D. (2000). Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet, 355, 1864- 1868. https://doi.org/10.1016/S0140-6736(00)02291-1
  6. Eggimann, P., & Pittet, D. (2002). Overview of catheter-related infections with special emphasis on prevention based on educational programs. Clinical Microbiology and Infection, 8(5), 295-309. https://doi.org/10.1046/j.1469-0691.2002.00467.x
  7. Erika, M., Young, D. O., Commiskey, M. L., & Wilson, S. J . (2006). Translating evidence into practice to prevent central venous catheter-associated bloodstream infections: A systems-based intervention. American J ournal of Infection Control, 34 (8). 503-506. https://doi.org/10.1016/j.ajic.2006.03.011
  8. Her, S., Kim, I. S., & Kim, K. H. (2008). Factors affecting on the level of practice on nosocomial infection management among operating room nurses. Journal of Korean Academy of Adult Nursing, 20(3), 375-385.
  9. Hu, K. K., Lipsky, B. A., Veestra, D. L., & Saint, S. (2004-a). Using maximal sterile barriers to prevent central venous catheter-related infection: A systemic evidence-based review. American Journal of Infection Control, 32(3), 142- 146. https://doi.org/10.1016/j.ajic.2003.10.006
  10. Hu, K. K., Veensta, D. L., Lipsky, B. A., & Saint, S. (2004-b). Use of maximal sterile barriers during central venous catheter insertion: Clinical and economic outcomes. Clinical Infectious diseases, 39, 1441-1445. https://doi.org/10.1086/425309
  11. Institute for Healthcare Improvement (2008, March). Implement the central line Bundle. Retrieved March 2, 2008, from http://www.ihi.org/IHI/Topics/CriticalCare/Intensive Care/Changes/ImplementtheCentralLineBundle.htm.
  12. Kim, K. M., Yoo, J . H., Choi, J . H., Park, E. S., Kim, K. S., Kim, K. S., et al. (2006). The nationwide surveillance results of nosocomial infections along with antimicrobial resistance in intensive care units of sixteen university hospital in Korea 2004. Korean Journal of Nosocomial Infection Control, 11(2), 79-86.
  13. Kim, N. C., & Choi, K. O. (2002). Effects on nurses' hand washing behavior and reduction of respiratory isolation rate of MRSA of the hand washing education. Journal of Korean Academy of Adult Nursing, 14(1), 26-33.
  14. Korean Association of Infection Control Nurses (2006). Text of Infection control. Seoul: Dongbabghanmoonhwa.
  15. Lobo, R. D., Levin, A. S., Brasileiro Gomes, L. M., Cursino, R., Park, M., Figueiredo, V. B., et al. (2005). Impact of an educational program and policy changes on decreasing catheter-associated bloodstream infections in a medical intensive care unit in Brazil. American Journal of Infection Control, 33 (2), 83-87. https://doi.org/10.1016/j.ajic.2004.05.003
  16. O'Grady, N. P., Alexander, M., Dellinger, E. P., Gerberding, J . L., Heard, S. O., Maki, D. G., et al. (2002). Guidelines for the prevention of intravascular catheter-related infections. Pediatrics, 110(5), 1-24.
  17. Pai, H. J ., Ha, M. N., Yoo, S. M., Rheem, I. S., Choi, D. S., Kim, S. S., et al. (1999). Cost-benefit analysis of infection control for blood stream infections associated with central venous catheters. Korean Journal of Nosocomial Infection Control, 4 (2), 217-225.
  18. Posa, P. J ., Harrison, D., & Vollman, K. M. (2006). Elimination of central line-associated bloodstream infections. Advanced Critical Care, 17, 446-454. https://doi.org/10.1097/01256961-200610000-00010
  19. Raad, I. I., Hohn, D. C., Gilbreath, B. J ., Suleiman, N., Hill, L. A., Bruso, P. A., et al. (1994). Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infection Control and Hospital Epidemiology, 15(4), 231-238. https://doi.org/10.1086/646902
  20. Rosenthal, V. D., Guzman, S., Pezzotto, S. M., & Crnich, C. J . (2003). Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care unit in Argentina. American Journal of Infection Control, 31(7), 405-409. https://doi.org/10.1067/mic.2003.52
  21. Rubinson, L., Haponik, E. F., Wu, A. W., & Diette, G. B. (2003). Internists' adherence to guidelines for prevention of intravascular catheter infections. The Journal of the American Medical Association, 290, 2802. https://doi.org/10.1001/jama.290.21.2802
  22. Sheretz, R. J ., Ely, E. W., Westbrook, D. M., Gledhill, K. S., Streed, S. A., Kiger, B., et al. (2000). Education of physicianin- training can decrease the risk of vascular catheter infection. Annals of Internal Medicine, 132 , 641-648.
  23. Song, J . H., Kim, S. G., Kim, Y. H., Kim, O. S., Yoon, S. W., Park, E. S., et al. (1999). Estimation of extra health care costs due to nosocomial bloodstream infections. Korean J ournal of Nosocomial Infection Control, 4(2), 205-216.
  24. Templeton, A., Schlegell, M., Fleisch, F., Rettenmund, G., Schöbi, B., Henz, S., et al. (2008). Multilumen central venous catheters increase risk for catheter-related bloodstream infection: Prospective surveillance study. Infection, 36(4), 322-327. https://doi.org/10.1007/s15010-008-7314-x
  25. Yang, N. Y., & Choi, J . S. (2009). Influenza A(H1N1) regional base hospital nurse's knowledge, awareness and practice of infection control. Journal of Korean Academy of Adult Nursing, 21(6), 593-602.
  26. Yilmaz, G., Koksal, I., Aydin, K., Caylan, R., Sucu, N., & Aksoy, F. (2007). Risk factors of catheter-related bloodstream infections in parenteral nutrition catheterization. Journal of Parenteral and Enteral Nutrition, 31(4), 284-287. https://doi.org/10.1177/0148607107031004284
  27. Yoo, J . Y., Kim, E. J ., Yun, I. S., Lee, J . S., Lee, J . Y., Byun, J . M., et al. (2007). Impact of maximal sterile barrier during the insertion of central venous catheters in adults intensive care units. Korean Journal of Nosocomial Infection Control, 12(1), 36-41.
  28. Yoo, S. M. (2001). Effectiveness of the surveillance of central venous catheter-related bloodstream infection in an intensive care unit. Unpublished doctoral dissertation, Seoul University, Seoul.
  29. You, H. S., Yang, I. H., & So, H. S. (2009). A university employee's knowledge, attitude toward, and practice of hospital infection wastes. Journal of Korean Academy of Adult Nursing, 21(1), 53-61.