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Incidence Rate and Variable Cost of Nosocomial Infections in Different Types of Intensive Care Units

Published online by Cambridge University Press:  02 January 2015

Yin-Yin Chen ,
Fu-Der Wang ,
Cheng-Yi Liu  and
Pesus Chou
Yin-Yin Chen
Affiliation:
Department of Infection Control, National Yang-Ming University, Taipei, Taiwan, Republic of China Department of Nursing, National Yang-Ming University, Taipei, Taiwan, Republic of China School of Nursing, National Yang-Ming University, Taipei, Taiwan, Republic of China
Fu-Der Wang
Affiliation:
Department of Infection Control, National Yang-Ming University, Taipei, Taiwan, Republic of China Division of Infectious Diseases, the Department of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
Cheng-Yi Liu
Affiliation:
Division of Infectious Diseases, the Department of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
Pesus Chou*
Affiliation:
Taipei Veterans General Hospital, and the Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, Republic of China
*
National Yang-Ming University, Institute of Public Health, Shih-Pai, Taipei, 112, Taiwan, R.O.C. (pschou@ym.edu.tw)
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Abstract

Objective.

Nosocomial infection (NI) is one of the most serious healthcare issues currently influencing healthcare costs. This study estimates the impact of NI on costs in intensive care units (ICUs).

Design.

Prospective surveillance by a retrospective cohort study.

Setting.

A medical ICU, a surgical ICU, and a mixed medical and surgical ICU in a large tertiary referral medical center.

Methods.

Surveillance for NIs was conducted for all patients admitted to adult ICUs from 2003 through 2005. Retrospective chart review was conducted for each patient. The generalized linear modeling approach was used to assess the relationship of NIs to the increase in variable costs in individual ICUs and in all ICUs.

Results.

A total of 401 NIs occurred in 320 of 2,757 screened patients. The incidence rate was 12.1% in the medical ICU, 14.7% in the surgical ICU, and 16.7% in the mixed medical and surgical ICU (P> .05). All of the mean variable costs were significantly higher for patients with NI than they were for patients without NI, after controlling for covariates. The medical ICU had the greatest increase in mean cost ($13,456, which was 3.52 times [95% confidence interval {CI}, 2.94–4.22 times] the mean cost for patients without NI), followed by the mixed medical and surgical ICU ($6,748, which was 2.74 times [95% CI, 2.33–3.22 times] the mean cost for patients without NI) and the surgical ICU ($5,433, which was 2.46 times [95% CI, 1.99–3.05 times] the mean cost for patients without NI). Mean cost increases according to the site of NI were $6,056 for bloodstream infection (2.36 times [95% CI, 1.97–2.84 times] the mean cost for patients without NI), $4,287 for respiratory tract infection (1.91 times [95% CI, 1.57–2.32 times] the mean cost for patients without NI), $1,955 for urinary tract infection (1.42 times [95% CI, 1.18–1.72 times] the mean cost for patients without NI), and $1,051 for surgical site infection (1.23 times [95% CI, 0.90–1.68 times] the mean cost for patients without NI).

Conclusions.

The medical ICU had the lowest rate of NI and the largest excess costs, the surgical ICU had the lowest excess costs, and the mixed medical and surgical ICU had the highest rate of NI. The cost is largely attributable to bloodstream infection and respiratory tract infection.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 1 , January 2009 , pp. 39 - 46
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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References

1.Shorr, AF. An update on cost-effectiveness analysis in critical care. Curr Opin Crit Care 2002;8:337–343.CrossRefGoogle ScholarPubMed
2.Kalb, PE, Miller, DH. Utilization strategies for intensive care units. JAMA 1989;261:2389–2395.CrossRefGoogle ScholarPubMed
3.Vincent, JL, Bihari, DJ, Suter, PM, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639–644.CrossRefGoogle Scholar
4.Eggimann, P, Pittet, D. Infection control in the ICU. Chest 2001;120:2059–2093.CrossRefGoogle ScholarPubMed
5.National Nosocomial Infections Surveillance (NNIS) System. NNIS System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.CrossRefGoogle Scholar
6.Chen, YY, Chou, YC, Chou, P. The impact of nosocomial infection on cost of illness and length of stay in intensive care units. Infect Control Hosp Epidemiol 2005;26:281–287.CrossRefGoogle ScholarPubMed
7.Renaud, B, Brun-Buisson, C. Outcomes of primary and catheter-related bacteremia: a cohort and case–control study in critically ill patients. Am J Respir Crit Care Med 2001;163:1584–1590.CrossRefGoogle ScholarPubMed
8.Dasta, JF, McLaughlin, TP, Mody, SH, et al. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crir Care Med 2005;33:1266–1271.CrossRefGoogle ScholarPubMed
9.Perencevich, EN, Stone, PW, Wright, SB, Carmeli, Y, Fisman, DN, Cosgrove, SE. Raising standards while watching the bottom line: making a business case for infection control. Infect Control Hosp Epidemiol 2007;28:1121–1133.Google Scholar
10.Anderson, DJ, Kirkland, KB, Kaye, KS, et al. Underresourced hospital infection control and prevention programs: penny wise, pound foolish? Infect Control Hosp Epidemiol 2007;28:767–773.Google Scholar
11.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–15601.Google Scholar
12.Digiovine, B, Chenoweth, C, Watts, C, et al. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160:976–981.CrossRefGoogle ScholarPubMed
13.Rosenthal, VD, Guzman, S, Migone, O, et al. The attributable cost and length of hospital stay of nosocomial pneumonia in intensive care units in three hospitals of Argentina: a prospective, matched analysis. Am J Infect Control 2005;33:157–161.CrossRefGoogle ScholarPubMed
14.Warren, DK, Quadir, WW, Hollenbeak, CS, et al. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med 2006;34:2084–2089.Google Scholar
15.Defez, C, Fabbro-Peray, P, Cazaban, M, Boudemaghe, T, Sotto, A, Daures, JP. Additional direct medical costs of nosocomial infections: an estimation from a cohort of patients in a French university hospital. J Hosp Infect 2008;68:130–136.Google Scholar
16.Pittet, D, Harbarth, SJ. The intensive care unit: part A. HAI epidemiology, risk factors, surveillance, engineering and administrative infection control practices, and impact. In: Jarvis, WR, ed. Hospital Infection. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2007:373–393.Google Scholar
17.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
18.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.CrossRefGoogle ScholarPubMed
19.Safdar, N, Dezfulian, C, Collard, HR, et al. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 2005;33:2184–93.CrossRefGoogle ScholarPubMed
20.Haley, RW. Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. Am J Med 1991;91:32S–38S.Google Scholar
21.Jarvis, WR, Edwards, JR, Culver, DH, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991;91:185S–191S.CrossRefGoogle ScholarPubMed
22.Sax, H, Hugonnet, S, Harbarth, S, et al. Variation in nosocomial infection prevalence according to patient care setting: a hospital-wide survey. J Hosp Infect 2001;48:27–32.CrossRefGoogle ScholarPubMed
23.Rosenthal, V, Maki, DG, Salomao, R, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med 2006;145:582–591.CrossRefGoogle ScholarPubMed
24.Gastmeier, P, Sohr, D, Geffers, C, Nassauer, A, Daschner, F, Ruden, Hl. Are nosocomial infection rates in intensive care units useful benchmark parameters? Infection 2000;28:346–350.Google Scholar
25.Centers for Disease Control and Prevention. Monitoring hospital-acquired infections to promote patient safety–United States, 1990-1999. MMWR 2000;49:149–153.Google Scholar
26.Edwards, JR, Peterson, KD, Andrus, ML, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2007;35:290–301.CrossRefGoogle ScholarPubMed
27.Stone, PW, Braccia, D, Larson, E. Systematic review of economic analyses of health care-associated infections. Am J Infect Control 2005;33:501–509.CrossRefGoogle ScholarPubMed