Resistors and constipators: Financial impact in an academic medical center, a mathematical model

The use of standardized central-line bundle kits (SCLBKs) is an infection prevention program that has proven to reduce central-line bloodstream infections (CLABSIs).2 Bathing patients with a 2% chlorhexidine gluconate (CHG) solution reduces annual CLABSIs and catheter-associated urinary tract infections (CAUTIs).3 We have shown that delays in implementing and increasing CHG compliance results in additional HAIs and costs.3 Here, we focus on the delay of implementing SCLBK and CHG bathing on CLABSI and CAUTI infections. Parameters Used in the Simulations Parameter Parameter Symbol Parameter Value Source Discharge rate for patients with central lines δCL 0.0556 (18 d) Dube et al6 Discharge rate for patients with CAUTI δCAUTI 0.0556 (18 d) Al-Hazmi et al7 Discharge rate for patients with central lines and catheters δBoth 0.0556 (18 d) Dube et al6 Discharge rate for patients with CLABSI δCLABSI 0.0417 (24 d) Dube et al6 Discharge rate for patients with catheters δCATH 0.1 Al-Hazmi et al7 Discharge rate for all other patients in the hospital δOther 0.2 Baek et al10 Probability of getting a central line ρCL 0.01232 Chopra et al8 Probability of getting a catheter ρCATH 0.01270 Carrouget et al9 Probability of getting both a central line and a catheter ρBoth 0.0001565 Chopra et al8, Carrouget et al9 Actual infection rate for those who have receieved a central line or both devices in \(i\) days \({r_i}\) \(\left( {1{\rm{\;}} - \frac{{\left( {3 - {\rm{i}}} \right) \cdot \eta \cdot {\rm{\kappa }}} \over {3}{\rm{\;}}} \right)r\) Calculated Actual infection rate for those who have received a catheter k days ago \({r_k}\) \(\left( {1{\rm{\;}} - \frac{{\left( {3 - {\rm{i}}} \right) \cdot {\rm{\kappa }}} \over {3}{\rm{\;}}} \right)r\) Calculated Reduction of incidence of CAUTI and CLABSI due to CHG bathing \(\eta \) 0.12, 0.6 Calculated Reduction of CLABSI due to the standardized kit \({\rm{\kappa }}\) 0.001–0.20 Calculated Infection rate \(r\) 0.00157–0.0007 Calculated One CHG bath costs $8.47. Al-Hazmi H. Role of duration of catheterization and length of hospital stay on the rate of catheter-related hospital-acquired urinary tract infections.