The Value of Quality Improvement Interventions for Catheter-Associated Urinary and Blood Stream Infections: A Systematic Review

Background:

Little is known about the economic value of quality improvement (QI) interventions, including those related to central-line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI).

Methods:

We searched MEDLINE, Econlit, the Centre for Reviews & Dissemination Economic Evaluations, Greylit, and Worldcat from January 1, 2004 to May 15, 2015; examined lists of references; and contacted experts. We selected English-language original research studies that described QI interventions related to CLABSI or CAUTI, measured or modeled the cost of the QI intervention, included both program costs and downstream financial effects, and were from developed countries. Dual reviewers extracted information related to the design, implementation, and reporting of the QI interventions and the economic analysis; extracted results related to clinical effectiveness and costs (program costs, downstream financial effects, net costs); and assessed the quality of the economic analyses using a modified version of the Quality of Health Economics Studies (QHES) Checklist (range 0 to 115).

Results:

Of 319 and 519 unique titles in the CLABSI and CAUTI searches, respectively, 15 and 3 studies were eligible. AHRQ-recommended practices were addressed in 13 studies on CLABSI (checklists, 7 studies; provider education, 13; ultrasound-guided placement, 3; all-inclusive catheter kits, 5; sterile dressings, 5; and others) and 3 of 3 studies on CAUTI (bladder bundles, 1; reminders or stop orders, 3; provider education, 3; and others). The median incidence rate ratio for CLABSI was 0.41 (IQR 0.51, 13 unique studies) and the range for CAUTI was 0.29-0.50 (2 studies). Median modified Quality of Health Economics Studies Checklist scores were 101 (IQR 9.5) for CLABSI and 102 (IQR 16) for CAUTI, relative to a maximum possible score of 115. Across 12 CLABSI studies, the median incremental net cost to the hospital over three years was -$1.52 million (IQR $1.55 million), standardized to 2015 U.S. dollars. Data on the value of CAUTI-related interventions were too limited to draw conclusions.  

Conclusions:

CLABSI prevention efforts are likely to be of high value to hospitals, relative to the status quo. In addition to improving patients’ health, hospitals are likely to experience moderate net savings within one to three years.  Further investigation of the economic value of CAUTI prevention is needed.