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Infection Control & Hospital Epidemiology Infection Control & Hospital Epidemiology

Article contents

An Economic Analysis of Adherence Engineering to Improve Use of Best Practices During Central Line Maintenance Procedures

Published online by Cambridge University Press:  16 March 2015

Richard E. Nelson ,
Aaron W. Angelovic ,
Scott D. Nelson ,
Jeremy R. Gleed  and
Frank A. Drews
Richard E. Nelson*
Affiliation:
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Aaron W. Angelovic
Affiliation:
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
Scott D. Nelson
Affiliation:
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah
Jeremy R. Gleed
Affiliation:
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
Frank A. Drews
Affiliation:
Department of Psychology, University of Utah, Salt Lake City, Utah
*
Address all correspondence to Richard E. Nelson, PhD, 500 Foothill Blvd, Salt Lake City, UT 84148 (richard.nelson@utah.edu).
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Abstract

OBJECTIVE

Adherence engineering applies human factors principles to examine non-adherence within a specific task and to guide the development of materials or equipment to increase protocol adherence and reduce human error. Central line maintenance (CLM) for intensive care unit (ICU) patients is a task through which error or non-adherence to protocols can cause central line-associated bloodstream infections (CLABSIs). We conducted an economic analysis of an adherence engineering CLM kit designed to improve the CLM task and reduce the risk of CLABSI.

METHODS

We constructed a Markov model to compare the cost-effectiveness of the CLM kit, which contains each of the 27 items necessary for performing the CLM procedure, compared with the standard care procedure for CLM, in which each item for dressing maintenance is gathered separately. We estimated the model using the cost of CLABSI overall ($45,685) as well as the excess LOS (6.9 excess ICU days, 3.5 excess general ward days).

RESULTS

Assuming the CLM kit reduces the risk of CLABSI by 100% and 50%, this strategy was less costly (cost savings between $306 and $860) and more effective (between 0.05 and 0.13 more quality-adjusted life-years) compared with not using the pre-packaged kit. We identified threshold values for the effectiveness of the kit in reducing CLABSI for which the kit strategy was no longer less costly.

CONCLUSION

An adherence engineering–based intervention to streamline the CLM process can improve patient outcomes and lower costs. Patient safety can be improved by adopting new approaches that are based on human factors principles.

Infect Control Hosp Epidemiol 2015;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 5 , May 2015 , pp. 550 - 556
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

1. Sax, H, Uckay, I, Richet, H, Allegranzi, B, Pittet, D. Determinants of good adherence to hand hygiene among healthcare workers who have extensive exposure to hand hygiene campaigns. Infect Control Hosp Epidemiol 2007;28:1267–1274.CrossRefGoogle Scholar
2. Drews, FA. Adherence engineering: a new approach to increasing adherence to protocols. Ergonomics in Design 2013;21:19–25.CrossRefGoogle Scholar
3. Berwick, DM. Disseminating innovations in health care. JAMA 2003;289:1969–1975.CrossRefGoogle Scholar
4. McGlynn, EA, Asch, SM, Adams, J, et al. The quality of health care delivered to adults in the United States. New Engl J Med 2003;348:2635–2645.CrossRefGoogle ScholarPubMed
5. Klevens, RM, Edwards, JR, Richards, CL Jr., et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122:160–166.CrossRefGoogle ScholarPubMed
6. Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510–515.CrossRefGoogle ScholarPubMed
7. Laupland, KB, Lee, H, Gregson, DB, Manns, BJ. Cost of intensive care unit-acquired bloodstream infections. J Hosp Infect 2006;63:124–132.CrossRefGoogle ScholarPubMed
8. Mermel, LA. Prevention of intravascular catheter-related infections. Ann Intern Med 7 2000;132:391–402.CrossRefGoogle ScholarPubMed
9. O’Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2002;23:759–769.CrossRefGoogle ScholarPubMed
10. DeLucia, PR, Ott, T, Palmieri, P. Performance in nursing. Rev Human Factor 2009;5:1–40.CrossRefGoogle Scholar
11. Parker, J, Coiera, E. Improving clinical communication: a view from psychology. J Am Med Inform Assoc 2000;7:453–461.CrossRefGoogle ScholarPubMed
12. Drews, FA, Musters, A, Samore, M. Error producing conditions in the intensive care unit. Advances in patient safety: from research to implementation. Vol 5. Rockville, MD: Agency for Healthcare Research and Quality; 2008.Google Scholar
13. Krueger, G. Sustained work, fatigue, sleep loss and performance: a review of the issues. Work & Stress 1989;3:129–141.CrossRefGoogle Scholar
14. Grundgeiger, T, Sanderson, P. Interruptions in healthcare: theoretical views. Int J Med Inform 2009;78:293–307.CrossRefGoogle ScholarPubMed
15. Grundgeiger, T, Sanderson, P, MacDougall, HG, Venkatesh, B. Interruption management in the intensive care unit: predicting resumption times and assessing distributed support. J Exp Psychol Appl 2010;16:317–334.CrossRefGoogle ScholarPubMed
16. Drews, FA, Bakdash, JZ, Mallin, BM. Adherence engineering: increasing adherence for central line maintenance procedures. 2014 (under review).Google Scholar
17. Galpern, D, Guerrero, A, Tu, A, Fahoum, B, Wise, L. Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit. Surgery 2008;144:492–495.CrossRefGoogle ScholarPubMed
18. Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.CrossRefGoogle Scholar
19. Angus, DC, Linde-Zwirble, WT, Sirio, CA, et al. The effect of managed care on ICU length of stay: implications for medicare. JAMA 1996;276:1075–1082.CrossRefGoogle ScholarPubMed
20. Wu, AW, Pronovost, P, Morlock, L. ICU incident reporting systems. J Crit Care Jun 2002;17:86–94.CrossRefGoogle ScholarPubMed
21. Young, MP, Birkmeyer, JD. Potential reduction in mortality rates using an intensivist model to manage intensive care units. Eff Clin Pract 2000;3:284–289.Google ScholarPubMed
22. Hall, MJ, Levant, S, DeFrances, CJ. Trends in inpatient hospital deaths: National Hospital Discharge Survey, 2000–2010. NCHS Data Brief, no 118. Hyattsville, MD: National Center for Health Statistics. 2013.Google ScholarPubMed
23. Stevens, V, Geiger, K, Concannon, C, Nelson, RE, Brown, J, Dumyati, G. Inpatient costs, mortality and 30-day re-admission in patients with central-line-associated bloodstream infections. Clin Microbiol Infect 2014;20:O318–O324.CrossRefGoogle ScholarPubMed
24. Halton, KA, Cook, DA, Whitby, M, Paterson, DL, Graves, N. Cost effectiveness of antimicrobial catheters in the intensive care unit: addressing uncertainty in the decision. Crit Care 2009;13:R35.CrossRefGoogle ScholarPubMed
25. Gold, MR, Franks, P, McCoy, KI, Fryback, DG. Toward consistency in cost-utility analyses: using national measures to create condition-specific values. Med Care 1998;36:778–792.CrossRefGoogle ScholarPubMed
26. Brouwer, W, Rutten, FFH, Koopmanschap, M. Costing in economic evaluations. In: Drummond M, McGuire A, eds. Economic evaluation in health care: merging theory with practice. New York, NY: Oxford University Press; 2001.Google Scholar
27. Graves, N, Harbarth, S, Beyersmann, J, Barnett, A, Halton, K, Cooper, B. Estimating the cost of health care-associated infections: mind your p's and q's. Clin Infect Dis 2010;50:1017–1021.CrossRefGoogle Scholar
28. Cooper, K, Frampton, G, Harris, P, et al. Are educational interventions to prevent catheter-related bloodstream infections in intensive care unit cost-effective? J Hosp Infect 2014;86:47–52.CrossRefGoogle Scholar
29. Ye, X, Rupnow, M, Bastide, P, Lafuma, A, Ovington, L, Jarvis, WR. Economic impact of use of chlorhexidine-impregnated sponge dressing for prevention of central line-associated infections in the United States. Am J Infect Control 2011;39:647–654.CrossRefGoogle Scholar
30. Stone, PW, Pogorzelska-Maziarz, M, Herzig, CT, et al. State of infection prevention in US hospitals enrolled in the National Health and Safety Network. Am J Infect Control 2014;42:94–99.CrossRefGoogle ScholarPubMed
31. Furuya, EY, Dick, A, Perencevich, EN, Pogorzelska, M, Goldmann, D, Stone, PW. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PloS One 2011;6:e15452.CrossRefGoogle Scholar
32. Pogorzelska, M, Stone, PW, Furuya, EY, et al. Impact of the ventilator bundle on ventilator-associated pneumonia in intensive care unit. Int J Qual Health Care 2011;23:538–544.CrossRefGoogle Scholar
33. Drews, FA. Human Error. In: Carayon P, ed. Handbook of Human Factors and Ergonomics in Healthcare and Patient Safety. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 2011.Google Scholar
34. Stevens, V, Geiger, K, Concannon, C, Nelson, RE, Brown, J, Dumyati, G. Inpatient costs, mortality and 3-day re-admission in patients with central-line-associated bloodstream infections. Clin Microbiol Infect 2014;20:318–324.CrossRefGoogle Scholar
35. Halton, KA, Cook, DA, Whitby, M, Paterson, DL, Graves, N. Cost effectiveness of antimicrobial catheters in the intensive care unit: addressing uncertainty in the decision. Crit Care 2009;13:R35.CrossRefGoogle ScholarPubMed
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