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Underresourced Hospital Infection Control and Prevention Programs: Penny Wise, Pound Foolish?

  • Deverick J. Anderson (a1), Kathryn B. Kirkland (a2), Keith S. Kaye (a1), Paul A. Thacker (a1), Zeina A. Kanafani (a1), Grace Auten (a1) and Daniel J. Sexton (a1)...
Abstract
Objectives.

To estimate the cost of healthcare-associated infections (HAIs) in a network of 28 community hospitals and to compare this sum to the amount budgeted for infection control programs at each institution and for the entire network.

Design.

We reviewed literature published since 1985 to estimate costs for specific HAIs. Using these estimates, we determined the costs attributable to specific HAIs in a network of 28 hospitals during a 1-year period (January 1 through December 31, 2004). Cost-saving models based on reductions in HAIs were calculated.

Setting.

Twenty-eight community hospitals in the southeastern region of the United States.

Results.

The weight-adjusted mean cost estimates for HAIs were $25,072 per episode of ventilator-associated pneumonia, $23,242 per nosocomial blood stream infection, $10,443 per surgical site infection, and $758 per catheter-associated urinary tract infection. The median annual cost of HAIs per hospital was $594,683 (interquartile range [IQR], $299,057-$l,287,499). The total annual cost of HAIs for the 28 hospitals was greater than $26 million. Hospitals budgeted a median of $129,000 (IQR, $92,500-$200,000) for infection control; the median annual cost of HAIs was 4.6 (IQR, 3.4-8.0) times the amount budgeted for infection control. An annual reduction in HAIs of 25% could save each hospital a median of $148,667 (IQR, $74,763-$296,861) and could save the group of hospitals more than $6.5 million.

Conclusions.

The economic cost of HAIs in our group of 28 study hospitals was enormous. In the modern age of infection control and patient safety, the cost-control ratio will become the key component of successful infection control programs.

Copyright
Corresponding author
DUMC Box 3824, Durham, NC 27710 (dja@duke.edu)
References
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1.Boyce, IM, Potter-Bynoe, G, Dziobek, L, Solomon, SL. Nosocomial pneumonia in Medicare patients: hospital costs and reimbursement patterns under the prospective payment system. Arch Intern Med 1991;151:11091114.
2.Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985;121:159167.
3.larvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552557.
4.Burke, JP. Infection control: a problem for patient safety. N Engl J Med 2003;348:651656.
5.larvis, WR. The state of the science of health care epidemiology, infection control, and patient safety, 2004. Am J Infect Control 2004;32:496503.
6.Institute for Healthcare Improvement. WOK Lives Campaign: Some Is Not a Number, Soon Is Not a Time. Cambridge, MA: Institute for Healthcare Improvement; 2006.
7.Joint Commission on Accreditation of Healthcare Organizations. Joint Commission Standards. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 2006.
8.Fraser, VJ. Starting to learn about the costs of nosocomial infections in the new millennium: where do we go from here? Infect Control Hosp Epidemiol 2002;23:174176.
9.Lauria, FN, Angeletti, C. The impact of nosocomial infections on hospital care costs. Infection 2003;31(suppl 2):3543.
10.Baker, AM, Meredith, JW, Haponik, EF. Pneumonia in intubated trauma patients: microbiology and outcomes. Am J Respir Crit Care Med 1996;153:343349.
11.Relio, J, Ollendorf, DA, Oster, G, et al.Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:21152121.
12.Haley, RW. Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. Am f Med 1991;9L32S38S.
13.US Bureau of Labor Statistics. Employment Cost Index. Available at: http://www.bls.gov/web/ecconst.pdf. Accessed May 14, 2007.
14.Board of Governors of the Federal Reserve System. US/Euro Foreign Exchange Rate. Available at: http://research.stlouisfed.org/fred2/data/DEXUSEU.txt. Accessed May 14, 2007.
15.Kaye, KS, Engemann, JJ, Fulmer, EM, Clark, CC, Noga, EM, Sexton, DJ. Favorable impact of an infection control network on nosocomial infection rates in community hospitals. Infect Control Hosp Epidemiol 2006;27:228232.
16.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.
17.Apisarnthanarak, A, Jones, M, Waterman, BM, Carroll, CM, Bernardi, R, Fraser, VJ. Risk factors for spinal surgicalsite infections in a community hospital: a case-control study. Infect Control Hosp Epidemiol 2003;24:3136.
18.Boyce, JM, Potter-Bynoe, G, Dziobek, L. Hospital reimbursement patterns among patients with surgical wound infections following open heart surgery. Infect Control Hosp Epidemiol 1990;11:8993.
19.Coello, R, Glenister, H, Fereres, J, et al.The cost of infection in surgical patients: a case-control study. J Hosp Infect 1993;25:239250.
20.Hollenbeak, CS, Murphy, DM, Koenig, S, Woodward, RS, Dunagan, WC, Fraser, VJ. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest 2000;118:397402.
21.Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725730.
22.VandenBergh, MF, Kluytmans, JA, van Hout, BA, et al.Cost-effectiveness of perioperative mupirocin nasal ointment in cardiothoracic surgery. Infect Control Hosp Epidemiol 1996;17:786792.
23.Vegas, AA, Jodra, VM, Garcia, ML. Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization. Eur J Epidemiol 1993;9:504510.
24.Whitehouse, JD, Friedman, ND, Kirkland, KB, Richardson, WJ, Sexton, DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002;23:183189.
25.Hugonnet, S, Eggimann, P, Borst, F, Maricot, P, Chevrolet, JC, Pittet, D. Impact of ventilator-associated pneumonia on resource utilization and patient outcome. Infect Control Hosp Epidemiol 2004;25:10901096.
26.Kappstein, I, Schulgen, G, Beyer, U, Geiger, K, Schumacher, M, Daschner, FD. Prolongation of hospital stay and extra costs due to ventilator-associated pneumonia in an intensive care unit. Eur J Clin Microbiol Infect Dis 1992;11:504508.
27.Papazian, L, Bregeon, F, Thirion, X, et al.Effect of ventilator-associated pneumonia on mortality and morbidity. Am J Respir Crit Care Med 1996;154:9197.
28.Warren, DK, Shukla, SJ, Olsen, MA, et al.Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med 2003;31:13121317.
29.Chen, YY, Chou, YC, Chou, P. Impact of nosocomial infection on cost of illness and length of stay in intensive care units. Infect Control Hosp Epidemiol 2005;26:281287.
30.Digiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160:976981.
31.Orsi, GB, Di Stefano, L, Noah, N. Hospital-acquired, laboratory-confirmed bloodstream infection: increased hospital stay and direct costs. Infect Control Hosp Epidemiol 2002;23:190197.
32.Pirson, M, Dramaix, M, Straelens, M, Riley, TV, Leclercq, P. Costs associated with hospital-acquired bacteraemia in a Belgian hospital. J Hosp Infect 2005;59:3340.
33.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:15981601.
34.Moris de la Tassa, J, Fernandez Munoz, P, Antuna Egocheaga, A, Gutierrez del Rio, MC, Carton Sanchez, JA. Estimating the costs associated with nosocomial urinary tract infection: a case-control study. Revista Clinica Espanola 2003;203:119124.
35.Wenzel, RP. The Lowbury Lecture: the economics of nosocomial infections. J Hosp Infect 1995;31:7987.
36.Graves, N. Economics and preventing hospital-acquired infection. Emerg Infect Dis 2004;10:561566.
37.Stone, PW, Larson, E, Kawar, LN. A systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990-2000. Am J Infect Control 2002;30:145152.
38.Medicare program; prospective payment system for long-term care hospitals RY 2007: annual payment rate updates, policy changes, and clarification: final rule. Federal Register 2006;71:2779727939.
39.Revised ICD-9-CMDRG Definitions Manual, Version 18.0. 18th ed. Murray, UT: 3M Health Information Systems; 2002.
40.Farber, BF. Reimbursement for nosocomial infections under the prospective payment plan: the future or decline of infection control? Infect Control 1984;5:425426.
41.Boyce, JM, Dziobek, L, Potter-Bynoe, G. Reimbursement for nosocomial infections. Ann Intern Med 1988;108:776.
42.Haley, RW, White, JW, Culver, DH, Hughes, JM. The financial incentive for hospitals to prevent nosocomial infections under the prospective payment system: an empirical determination from a nationally representative sample. JAMA 1987;257:16111614.
43.Haley, RW, Culver, DH, White, JW, et al.The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182205.
44.Reduction in central line-associated bloodstream infections among patients in intensive care units: Pennsylvania, April 2001-March 2005. MMWR Morb Mortal Wkly Rep 2005;54:10131016.
45.Babcock, HM, Zack, JE, Garrison, T, et al.An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects. Chest 2004;125:22242231.
46.Wakefield, DS, Pfaller, MA, Hammons, GT, Massanari, RM. Use of the appropriateness evaluation protocol for estimating the incremental costs associated with nosocomial infections. Med Care 1987;25:481488.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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