Improving CLABSI outcomes and reducing costs by modular training in a resource-limited setting


Intravenous literature: Singh, S., Kumar, R.K., Sundaram, K.R., Kanjilal, B. and Nair, P. (2012) Improving outcomes and reducing costs by modular training in infection control in a resource-limited setting. International Journal for Quality in Health Care. Oct 16. [Epub ahead of print].


OBJECTIVE: To study the impact of modular training and implementation of infection control practices on all health-care-associated infections (HAIs) in a cardiac surgery (CVTS) program of a tertiary care hospital.

DESIGN: Baseline data were compared with post-intervention (with modular training) data.

SETTING: This study was conducted in a cardiovascular surgical unit.

PARTICIPANTS: In total, 2838 patients were admitted in cardiovascular surgical service.

INTERVENTIONS: Two training modules and online continuous education were delivered to all health-care workers in CVTS unit.

MAIN OUTCOME MEASURES: All four HAIs, such as surgical site infections (SSI), central line-associated blood stream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CA-UTI), were studied. Additional outcome measures included average length of stay cost of avoidance mortality and readmission rates.

RESULTS: The SSI rate had decreased in the post-intervention phase from 46 to 3.27% per 100 surgeries (P < 0.0001), CLABSI had decreased from 44 to 3.10% per 1000 catheter days (P < 0.009), VAP was reduced from 65 to 4.8% per 1000 ventilator days (P < 0.0001) and CA-UTI had reduced from 37 to 3.48% per 1000 urinary catheter days (P < 1.0). For every $1 spent on training, the return on investment was $236 as cost of avoidance of healthcare associated infections (HAIs).

CONCLUSIONS: Standardization of infection control training and practices is the most cost-effective way to reduce HCAIs and related adverse outcomes.

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