Analysis of the efficiency and cost of a care bundle for prevention of common infections in an intensive care unit: A quasi-experimental pretest-posttest design study

Year 2022, , 398 - 405, 29.06.2022

Gülay Yazıcı , Hülya Bulut , Burcu Bayrak Kahraman , Tunçay Palteki

https://doi.org/10.18521/ktd.1109974

Abstract

Objective
Healthcare-associated infections, threaten patient safety, cause prolonged hospitalization, morbidity, mortality and increased costs. This study was conducted to evaluate the effectiveness of interventions to prevent healthcare-associated infections and the effect of these interventions on cost.
Methods
A quasi-experimental pretest-posttest design study was completed between 1 January and 30 June 2018, and 1 October 2018 and 31 March 2019, in an intensive care unit, with a total of 54 patients, 27 pre-training and 27 post-training.
Results
In the study, infection rates were 20.34 in January to March 2018, 25.7 in April to June 2018, 20.97 in October to December 2018 and 17.77 in January to March 2019. When the infection rates of the four different periods were compared, it was found that there was a decrease compared to the pre-training period but that this decrease was not statistically significant (p>0.05). The average cost before the training was 11361.35₺ and the average cost after the training was 9149.87₺. Average bed costs, which are the most important of all costs, decreased by 25.7% compared to pre-training at the 95% confidence interval (5241.86₺-13251.50₺ and 3489.03₺-10257.41₺, respectively).
Conclusion
In conclusion, the study determined that training provided a significant increase in the intensive care nurses’ scores related to healthcare-associated infections and there were decreases in healthcare-associated infection rates, lengths of hospital stay and cost after the training although these were not statistically significant.

Keywords

Healthcare-associated infections, Care Bundle, Nursing, Cost

Bir yoğun bakım ünitesinde sık görülen enfeksiyonların önlenmesi için bir bakım paketinin etkinlik ve maliyetinin analizi: Yarı deneysel bir öntest-sontest tasarım çalışması

Abstract

Amaç
Sağlık hizmeti ilişkili enfeksiyonlar hasta güvenliğini tehdit etmekte, hastanede yatış süresinin uzamasına, morbidite, mortalite ve maliyetlerin artmasına neden olmaktadır. Bu çalışma, sağlık hizmeti ilişkili enfeksiyonları önlemeye yönelik müdahalelerin etkinliğini ve bu müdahalelerin maliyete etkisini değerlendirmek amacıyla yapılmıştır.
Metod
Bu araştırma bir yoğun bakım ünitesinde 1 Ocak – 30 Haziran 2018 ile 1 Ekim 2018 – 31 Mart 2019 tarihleri arasında 27 eğitim öncesi ve 27 eğitim sonrası olmak üzere toplam 54 hasta ile yarı deneysel ön test-son test tasarım çalışması olarak yapılmıştır.
Bulgular
Çalışmada enfeksiyon oranları Ocak-Mart 2018'de 20.34, Nisan-Haziran 2018'de 25.7, Ekim-Aralık 2018'de 20.97 ve Ocak-Mart 2019'da 17.77 olarak bulunmuştur. Dört farklı dönemin enfeksiyon oranları karşılaştırıldığında, eğitim öncesine göre eğitim sonrasında enfeksiyon oranlarında azalma olduğu ancak bu düşüşün istatistiksel olarak anlamlı olmadığı saptanmıştır (p>0.05). Eğitim öncesi ortalama maliyet 11361.35₺, eğitim sonrası ortalama maliyet 9149.87₺ olarak belirlenmiştir. Tüm maliyetlerin en önemlisi olan ortalama yatak maliyeti eğitim öncesine göre %95 güven aralığında %25,7 oranında azalmıştır. (5241.86₺-13251.50₺, sırasıyla 3489.03₺-10257.41₺).
Sonuç
Sonuç olarak, çalışmada eğitimin yoğun bakım hemşirelerinin sağlık hizmeti ilişkili enfeksiyonlara ilişkin puanlarında anlamlı bir artış sağladığı, sağlık hizmeti ilişkili enfeksiyon oranlarında, hastanede kalış sürelerinde ve eğitim sonrası maliyette istatistiksel olarak anlamlı olmasa da azalma sağladığı belirlenmiştir.

Keywords

Sağlık hizmeti ilişkili enfeksiyonlar, maliyet., Bakım Paketi, Hemşirelik, Maliyet

References

• References 1. Hatachi T, Tachibana K, Takeuchi M. Incidences and influences of device-associated healthcare-associated infections in a pediatric intensive care unit in Japan: a retrospective surveillance study. J of intensive care. 2015;3: 1-7.
• 2. Alemu AY, Endalamaw A, Bayıh WA. The burden of healthcare-associated infection in Ethiopia: a systematic review and meta-analysis. Trop med health. 2020; 48: 1-11.
• 3. Gupta P, Thomas M, Patel A, et al. Bundle approach used to achieve zero central line-associated bloodstream infections in an adult coronary intensive care unit. BMJ Open Quality. 2020;10: e001200. doi:10.1136/bmjoq-2020-001200
• 4. Haque M, McKimm J, Sartelli M, et al. Strategies to prevent healthcare-associated infections: a narrative overview. Risk Manag Healthc Policy. 2020;13: 1765-1780. doi: 10.2147/RMHP.S269315
• 5. Yokoe DS, Classen D. Improving patient satey through infection control. Infect Control Hosp Epidemiol. 2008;29:3-11.
• 6. Eom JS, Lee MS, Chun HK, et al. The impact of a ventilator bundle on preventing ventilator-associated pneumonia: a multicenter study. Am J Infect Control. 2014;42:34-37. doi: 10.1016/j.ajic.2013.06.023.
• 7. Helmick RA, Knofsky ML, Braxton CC, et al. Mandated self-reporting of ventilator-associated pneumonia bundle and catheter-related bloodstream infection bundle compliance and infection rates. JAMA Surg. 2014;149: 16–27. doi: 10.1001/jamasurg.2014.1627.
• 8. Horner DL, Bellamy MC. Care bundles in intensive care. BJA Educ. 2012;12:199-202. doi:10.1093/bjaceaccp/mks021
• 9. Yazıcı G, Bulut H. Efficacy of a care bundle to prevent multiple infections in the intensive care unit: A quasi-experimental pretest-posttest design study. Appl Nurs Res. 2018; 39: 4–10. doi: 10.1016/j.apnr.2017.10.009
• 10. Friedman C, Borg M, Allegranzi B, et al. The costs of healthcare associated infections. IFIC basic concepts of infection control. 3rd Edition. Portadown, BT62 3WG, N Ireland, UK. 2016
• 11. Álvarez-Lerma F, Palomar-Martínez M, Sánchez-García M, et al. Prevention of ventilator-associated pneumonia: the multimodal approach of the Spanish ICU “Pneumonia Zero” Program. Crit Care Med. 2018;46:181-188. doi: 10.1097/CCM.0000000000002736.
• 12. Hakko E, Guvenc S, Karaman I, et al. Long-term sustainability of zero central-line associated bloodstream infections is possible with high compliance with care bundle elements. East Mediterr Health J. 2015; 21:293-298. doi: 10.26719/2015.21.4.293.
• 13. Lim KC, Gani YM, Sim LB, et al. Zero bloodstream infection in medical wards: Achievable?. International Journal of Infectious Diseases, 2020;101:301. doi: 10.1016/j.ijid.2020.09.788
• 14. Alp E, Kılıç AU, Tanrıverdi T, et al. Enfeksiyon Kontrol Programı. 2012. http://www.hastaneler.Erciyes.edu.tr/pdf/enfeksiyon kontrol programi.pdf, Accessed September12, 2021.
• 15. Arda B, Ateş K, Bakır M, et al. Üriner Kateter İnfeksiyonlarının Önlenmesi Klavuzu. Hastane İnfeksiyonları Dergisi, 2012;16:1-18.
• 16. Arman D, Arda B, Çetinkaya Şardan Y, et al. Sağlık Hizmeti İle İlişkili Pnömoninin Önlenmesi Kılavuzu. Hastane İnfeksiyonları Dergisi 2008; 12: 2.
• 17. Çetinkaya-Şardan Y, Güner R, Çakar N, et al. Damar İçi Kateter İnfeksiyonlarının Önlenmesi Kılavuzu. Hastane İnfeksiyonları Dergisi 2013;17: 233-279.
• 18. O'Grady NP, Alexander M, Burns L, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52:e162-e193. doi: 10.1093/cid/cir257
• 19. Pittet D, Allegranzi B, Storr S, et al. Infection control as a major World Health Organization priority for developing countries. J Hosp Infect. .2008;68:285-292. doi: 10.1016/j.jhin.2007.12.013.
• 20. Usluer G, Esen Ş, Dokuzoğuz B, et al. İzolasyon Önlemleri Kılavuzu. Hastane İnfeksiyonları Dergisi 2006;10: 1-28.
• 21. Rosenthal VD, Maki DG, Salomao RA, et al. Device-associated nosocomial infections in 55 intensive care units of developing countries. Ann Intern Med. 2006;145:582-591. doi: 10.7326/0003-4819-145-8-200610170-00007.
• 22. Safdar N, Dezfulian C, Collard HR, et al. Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Crit Care Med. .2005;33:2184-2193. doi: 10.1097/01.ccm.0000181731.53912.d9.
• 23. Moura J, Baylina P, Moreira P. Exploring the real costs of healthcare-associated infections: an international review. Int J Healthc Manag. 2018;11:333-340. Doi: 10.1080/20479700.2017.1330729
• 24. Osme SF, Souza JM, Osme IT, et al. Financial impact of healthcare-associated infections on intensive care units estimated for fifty Brazilian university hospitals affiliated to the unified health system. J Hosp Infect. 2021;117: 96-102. doi: 10.1016/j.jhin.2021.08.012.
• 25. Acun A, Caliskan N. Evaluation of effectiveness of central venous catheter related bloodstream infections in the antesty and reanimation intensive care units of the bundle. Annals of Medical Research 2021;28: 792-798. doi: 10.5455/annalsmedres.2020.06.587
• 26. Mazi WA, Abdulwahab MH, Alashqar MA, et al. Sustained Low Incidence Rates of Central Line-Associated Blood Stream Infections in the Intensive Care Unit. Infect Drug Resist. 201;14: 889-894. doi: 10.2147/IDR.S290791.
• 27. Radhakrishnan R, Sood R, Wig N, et al. Effect of Training and Checklist Based Use of Ventilator Associated Pneumonia (VAP) Prevention Bundle Protocol on Patient Outcome: A Tertiary Care Centre Study. J Assoc Physicians India. . 2021;69:11-12.
• 28. Shaban AM, El-Mokadem NM, Shaimaa EL. Effectiveness of Implementing Ventilator Associated Pneumonia Prevention Bundle among Mechanically Ventilated Patients. International Journal of Novel Research in Healthcare and Nursing 2021;8: 329-342.
• 29. Devrim İ, Yaşar N, İşgüder R, et al. Clinical impact and cost-effectiveness of a central line bundle including split-septum and single-use prefilled flushing devices on central line–associated bloodstream infection rates in a pediatric intensive care unit. Am J Infect Control. 2016;44:e125-e128. doi: 10.1016/j.ajic.2016.01.038.
• 30. Halton KA., Cook D, Paterson DL, et al. Cost-effectiveness of a central venous catheter care bundle. PLoS One 2010;5: e12815. doi: 10.1371/journal.pone.0012815.
• 31. Sedrak AS, Ibrahem SK, Rady H, et al. Cost Effectiveness Analysis of Bundle versus No Bundle Strategy during Central Venous Catheter Insertion on Reduction of Central LineAssociated Bloodstream Infections in Abu El Reesh Hospital, Egypt. The Egyptian Journal of Community Medicine 2019;37:39-50. doi: 10.21608/EJCM.2019.54289
• 32. Jia H, Li L, Li W, et al. Impact of healthcare-associated infections on length of stay: a study in 68 hospitals in China. Biomed Res Int. 2019; 2019:2590563. doi: 10.1155/2019/2590563.
• 33. Stewart S, Robertson C, Pan J, et al. Impact of healthcare-associated infection on length of stay. J Hosp Infect. 2021;114:23-31. doi: 10.1016/j.jhin.2021.02.026.
• 34. Leal, M. A., & Freitas-Vilela, A. A. D., 2021. Costs of healthcare-associated infections in an Intensive Care Unit. Rev Bras Enferm. 2021;74:e20200275. doi: 10.1590/0034-7167-2020-0275. 33
• 35. Humphrey J.S. Improving registered nurses' knowledge of evidence-based practice guidelines to decrease the incidence of central line-associated bloodstream infections: an educational intervention. Journal of the Association for Vascular Access 2015;20:143-149. doi: 10.1016/j.java.2015.05.003
• 36. Kakkar SK, Bala M, Arora V. Educating nursing staff regarding infection control practices and assessing its impact on the incidence of hospital-acquired infections. J Educ Health Promot. 2021;28:40. doi: 10.4103/jehp.jehp_542_20. eCollection 2021.
• 37. Abdelaziz ME. The impact of compliance to VAP bundle of care on the VAP rates in three adult ICUs. J AIDS Clin Res 2019;10 (14th International Conference): 31. Doı: 10.4172/2155-6113-C2-032 34
• 38. Furuya EY, Dick AW, Herzig CT, et al. Central line–associated bloodstream infection reduction and bundle compliance in intensive care units: a national study. Infect Control Hosp Epidemiol. 2016;37:805-810. doi: 10.1017/ice.2016.67. 35