Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review

Abstract

BackgroundHospitals have implemented diverse quality improvement (QI) interventions to reduce rates of catheter-associated urinary tract infections (CAUTIs). The economic value of these QI interventions is uncertain.ObjectiveTo systematically review economic evaluations of QI interventions designed to prevent CAUTI in acute care hospitals.MethodsA search of Ovid MEDLINE, Econlit, Centre for Reviews & Dissemination, New York Academy of Medicine’s Grey Literature Report, WorldCat, IDWeek conference abstracts and prior systematic reviews was conducted from January 2000 to October 2020.We included English-language studies of any design that evaluated organisational or structural changes to prevent CAUTI in acute care hospitals, and reported programme and infection-related costs.Dual reviewers assessed study design, effectiveness, costs and study quality. For each eligible study, we performed a cost-consequences analysis from the hospital perspective, estimating the incidence rate ratio (IRR) and incremental net cost/savings per hospital over 3 years. Unadjusted weighted regression analyses tested predictors of these measures, weighted by catheter days per study.ResultsFifteen unique economic evaluations were eligible, encompassing 74 hospitals. Across 12 studies amenable to standardisation, QI interventions were associated with a 43% decline in infections (mean IRR 0.57, 95% CI 0.44 to 0.70) and wide ranges of net costs (mean US$52 000, 95% CI −$288 000 to $392 000), relative to usual care.ConclusionsQI interventions were associated with large declines in infection rates and net costs to hospitals that varied greatly but that, on average, were not significantly different from zero over 3 years. Future research should examine specific practices associated with cost-savings and clinical effectiveness, and examine whether or not more comprehensive interventions offer hospitals and patients the best value.

Quality improvement interventions to prevent the use of hospital services among nursing home residents: protocol for a systematic review and meta-analysis

“…20 Previous experiences in hospital acute care settings found QI interventions beneficial in enhancing process care outcomes, such as organisational culture or teamwork, and improving patient care, by reducing the nosocomial infection rate, preventing falls or improving surgical outcomes. [21][22][23][24] Although previous studies have obtained encouraging results related to QI interventions, evidence of its effectiveness in NH remain limited. 25 26 In particular, the INTERACT II intervention significantly reduced hospital admissions through a multicomponent QI intervention aimed at training NH staff to identify and proactively manage major geriatric syndromes, encouraging advanced care planning and promoting palliative care-oriented care.…”

When Infections Are Found: A Qualitative Study Characterizing Best Management Practices for Central Line-Associated Bloodstream Infection and Catheter-Associated Urinary Tract Infection Performance Monitoring and Feedback

“…Healthcare-associated infections (HAIs), including central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) contribute to increased patient morbidity and mortality while adding unnecessary costs to healthcare [ 1 , 2 , 3 ]. Since HAIs are largely preventable, clinical bundles have been created and promulgated to reduce the occurrence of HAIs.…”

Exploring Nitrogen-Functionalized Graphene Composites for Urinary Catheter Applications

“…Although UCs are valuable instruments in healthcare settings, they are linked to serious complications, such as urinary tract infections (UTIs). UTIs are the most common type of healthcare-associated infection, with approximately 75% of episodes resulting from the insertion of a UC [ 1 , 2 ]. Catheter-associated urinary tract infections (CAUTIs) have a significant impact on both patient health and the economic burden of healthcare systems [ 1 , 3 , 4 ].…”