Open versus closed IV infusion systems: a state based model to predict risk of catheter associated blood stream infections

OBJECTIVES: To quantify the change in risk of central line associated blood stream infection (CLABSI) following the introduction of a closed infusion container in intensive care units (ICUs) in two Latin American cities. DESIGN: A state-space model was used to describe the flow of admissions through the ICU. This approach correctly treats infection as a time-dependent covariate. RESULTS: A closed system reduced the risk of CLABSI. The hazard ratios for the closed versus open container were between 0.15 and 0.31 (p values<0.001), indicating a clinically significant reduction in the risk of admissions having a CLABSI. A simulation study showed that a closed system reduced the number of infections, costs and deaths. CONCLUSIONS: The data reveal costs are saved and health benefits gained from fewer cases of CLABSI after adoption of a closed infusion system. Information is required on the costs of implementing the closed system widely in these settings.