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Reducing catheter-associated bloodstream infections in the pediatric intensive care unit: Business case for quality improvement

Nowak, Jeffrey E. MD1; Brilli, Richard J. MD; Lake, Michael R. MA1; Sparling, Karen W. CPA, MBA; Butcher, John RN; Schulte, Marion RN; Wheeler, Derek S. MD

Pediatric Critical Care Medicine: September 2010 - Volume 11 - Issue 5 - p 579-587
doi: 10.1097/PCC.0b013e3181d90569
Continuing Medical Education Articles

Objective: To determine whether catheter-associated bloodstream infections were associated with increased lengths of stay in pediatric intensive care units and hospitals and increased healthcare costs in critically ill children. Previous studies have shown that hospital-acquired bloodstream infections are associated with longer stays in pediatric intensive care units, increased hospital costs, and increased hospital mortality. Catheter-associated bloodstream infections comprise the vast majority of hospital-acquired bloodstream infections.

Design: Retrospective, case-matched, cohort study and financial analysis.

Setting: University-affiliated children's medical center.

Patients: Twenty-two critically ill children with catheter-associated bloodstream infections and their matched controls.

Interventions: None.

Measurements and Main Results: We compared the length of stay, mortality, and hospital costs in critically ill children with catheter-associated bloodstream infections and matched controls. The presence of catheter-associated bloodstream infections extended the entire hospital length of stay by 9 days (6.5 days while in the pediatric intensive care unit) and increased hospital costs by $33,039, primarily driven by the increase in length of stay days. Quality improvement efforts directed at reducing the prevalence of catheter-associated bloodstream infections during the period of study decreased total hospital days by 354, reduced total hospital costs by $1,298,271, and reduced total costs to payers by $1,415,676.

Conclusion: The potential cost savings from reducing or eliminating catheter-associated bloodstream infections in the pediatric intensive care unit are significant. Elimination of catheter-associated bloodstream infections will directly reduce hospital costs, improve asset utilization, and most importantly, improve clinical care.

Pediatric Critical Care Physician (JEN), Children's Respiratory and Critical Care Specialists, Minneapolis, MN; Chief Medical Officer (RJB), Nationwide Children's Hospital, Columbus, OH; Financial Analyst (MRL), Office of Budget and Financial Analysis, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Associate Vice President—Perinatal Institute (KWS), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Data Manager (JB), Critical Care Medicine, Cincinnati Children's Hospital Medical Center; Cincinnati, OH; Data Manager (MS), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Associate Professor of Clinical Pediatrics (DSW), University of Cincinnati College of Medicine, Cincinnati, OH; and Clinical Director (DSW), Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

1Both authors contributed equally to this work.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: derek.wheeler@cchmc.org

©2010The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies