Closed ICUs are associated with significantly reduced rates of catheter-associated urinary tract infections, central line-associated bloodstream infections and ventilator-acquired pneumonia, researchers reported at the American Thoracic Society International Conference.
Patients in closed ICUs are evaluated and admitted under an intensivist, and the ICU team handles any orders involving patient care, whereas patients in open ICUs are evaluated and admitted under a primary care physician, with the intensivist acting as a consultant and orders being written by consultants directly, explained Ahmad Sharayah, MD, an internist at Monmouth Medical Center in Long Branch, New Jersey, and colleagues.
“Transitioning ICU care from [an] open to [a] closed model results in fewer hospital-acquired infections and lower health care costs,” Sharayah told Infectious Disease News.
Sharayah and colleagues conducted a retrospective data analysis on rates of catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), MRSA blood infection, Clostridioides difficile infection (CDI) and ventilator-acquired pneumonia (VAP) at a community medical center. They compared the rate of infections under an open ICU model from July 2014 to June 2016 with rates of infection under a closed ICU model implemented from July 2016 to June 2018.
The researchers observed a 19.3% reduction in CLABSI rates (P = .04), a 100% reduction in CAUTI rates (P = .03), and a 100% reduction in VAP rates (P = .02). Specifically, they reported 1.71 CLABSI cases per 1,000 catheter-days in the open ICU model compared with 0.33 cases per 1,000 catheter-days in the closed ICU model. There were 2.1 CAUTI cases and 1.9 VAP cases per 1,000 catheter-days in the open ICU model compared with zero cases in the closed ICU model.
However, rates of MRSA blood infection (P = 1) and CDI (P = .87) demonstrated no significant change. In the open ICU model, there were 1.49 CDI cases and 0.38 MRSA cases per 1,000 catheter-days, whereas the closed ICU model had 2.94 CDI cases and 0.44 MRSA cases per 1,000 catheter-days.
The researchers suggested that infectious complications can be prevented when care is systemically delivered under a single, centralized leadership.
“Closed ICU under the care of an intensivist resulted in less CLABSI, CAUTI and VAP,” Sharayah said. “Our study did not show change in the [CDI] rate and [MRSA] bloodstream infection rate; further research with bigger sample size is required to demonstrate if there is a change or not.” – by Marley Ghizzone
Sharayah A, et al. Abstract A6472/P675. Presented at: American Thoracic Society International Conference; May 17-22, 2019; Dallas.
Disclosures: The authors report no relevant financial disclosures.