Impact of VAP Bundle and Central Line Bundle on infection control in resource limited setting

Background: Plastic & Reconstructive Surgery (PRS) is one of fastest growing specialties owing to medical tourism in India. There is a paucity of healthcare associated infection (HAI) data in a resource limited setting. Due to lack of medical insurance, cost of medical expenses are borne by the patient directly in India.

Objective: To measure the burden of device associated infections (DAI) and assess the impact of intervention bundles and the cost saving.

Methods: The study was conducted in a 14 bedded PRS-ICU from 2009 to 2010 in a university teaching hospital. Baseline data was collected from Jan 2009 to Oct 2010. Ventilator & central line intervention bundles were implemented in Oct 2009 after rigorous training and education of all stakeholders. The SHEA compendium bundle was followed for ventilator use and patients on central line. The SHEA compendium bundles for ventilator use and patients on central line were implemented in Oct 2009 after rigorous training and education of all stakeholders. Outcome was measured as length of stay (LOS), and mortality. Direct cost was calculated taking procedural billing, ancillary cost of lab, imaging and pharmacy. Indirect cost was calculated by patient's loss of job days, attendant’s loss of job days, stay, meals etc. Opportunity cost was assessed by admitting more surgical patients owing to reduction in LOS.

Results:

VAP and CR-BSI was reduced by half from 6.27 to 3.23 per 1000 ventilator days and 5.6 to 3.2 per 1000 line days respectively during the study period. The excess mortality because of VAP and CR-BSI was 26.13% and 33.45% respectively. The compliance of VAP Bundle was 50% in pre intervention period which increased to 85% in post intervention period. The central line bundle compliance also increased from 45% to 88% in post intervention period. LOS was reduced by 8 days for VAP and 6.8 days for CR-BSI. The mortality was reduced by 23% in VAP and 15% in CR-BSI. The estimated total reduction in direct cost saving for both VAP and CR-BSI was approx $87328 (Rs. 41, 04,042) and indirect cost savings was $38213 (Rs.17, 96,050). Opportunity cost during the interventional period was $178885 (Rs. 84, 07,600).The total cost saving in the PRS owing to implementation of VAP and central line bundle was $ 406713 (Rs. 1,50,16,500).

Conclusions: It is possible to reduce VAP and CR-BSI in a resource limited setting by using the SHEA compendium intervention bundles.