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

Part of: BARRY FARR AWARD RECIPIENTS Developing an Infection Control Program

Published online by Cambridge University Press:  02 January 2015

Deverick J. Anderson ,
Kathryn B. Kirkland ,
Keith S. Kaye ,
Paul A. Thacker II ,
Zeina A. Kanafani ,
Grace Auten  and
Daniel J. Sexton
Deverick J. Anderson*
Affiliation:
Division of Infectious Disease and International Health, Department of Medicine, and Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
Kathryn B. Kirkland
Affiliation:
Section of Infectious Diseases and International Health, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Keith S. Kaye
Affiliation:
Division of Infectious Disease and International Health, Department of Medicine, and Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
Paul A. Thacker II
Affiliation:
Division of Infectious Disease and International Health, Department of Medicine, and Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
Zeina A. Kanafani
Affiliation:
Division of Infectious Disease and International Health, Department of Medicine, and Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
Grace Auten
Affiliation:
Division of Infectious Disease and International Health, Department of Medicine, and Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Division of Infectious Disease and International Health, Department of Medicine, and Duke Infection Control Outreach Network, Duke University Medical Center, Durham, North Carolina
*
DUMC Box 3824, Durham, NC 27710 ([email protected])
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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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 7 , July 2007 , pp. 767 - 773
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

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;151:1109–1114.CrossRefGoogle ScholarPubMed
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;121:159–167.Google Scholar
3.larvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552–557.Google Scholar
4.Burke, JP. Infection control: a problem for patient safety. N Engl J Med 2003;348:651–656.Google Scholar
5.larvis, WR. The state of the science of health care epidemiology, infection control, and patient safety, 2004. Am J Infect Control 2004;32:496–503.Google Scholar
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.Google Scholar
7.Joint Commission on Accreditation of Healthcare Organizations. Joint Commission Standards. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 2006.Google Scholar
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;23:174–176.CrossRefGoogle Scholar
9.Lauria, FN, Angeletti, C. The impact of nosocomial infections on hospital care costs. Infection 2003;31(suppl 2):35–43.Google ScholarPubMed
10.Baker, AM, Meredith, JW, Haponik, EF. Pneumonia in intubated trauma patients: microbiology and outcomes. Am J Respir Crit Care Med 1996;153:343–349.Google Scholar
11.Relio, J, Ollendorf, DA, Oster, G, et al.Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:2115–2121.CrossRefGoogle Scholar
12.Haley, RW. Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. Am f Med 1991;9L32S–38S.Google Scholar
13.US Bureau of Labor Statistics. Employment Cost Index. Available at: http://www.bls.gov/web/ecconst.pdf. Accessed May 14, 2007.Google Scholar
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.Google Scholar
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;27:228–232.Google Scholar
16.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
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;24:31–36.Google Scholar
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;11:89–93.Google Scholar
19.Coello, R, Glenister, H, Fereres, J, et al.The cost of infection in surgical patients: a case-control study. J Hosp Infect 1993;25:239–250.Google Scholar
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;118:397–402.Google Scholar
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;20:725–730.Google Scholar
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;17:786–792.Google Scholar
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;9:504–510.Google Scholar
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;23:183–189.CrossRefGoogle Scholar
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;25:1090–1096.Google Scholar
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;11:504–508.Google Scholar
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;154:91–97.Google Scholar
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;31:1312–1317.Google Scholar
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;26:281–287.Google Scholar
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;160:976–981.Google Scholar
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;23:190–197.Google Scholar
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;59:33–40.CrossRefGoogle Scholar
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;271:1598–1601.Google Scholar
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;203:119–124.Google Scholar
35.Wenzel, RP. The Lowbury Lecture: the economics of nosocomial infections. J Hosp Infect 1995;31:79–87.Google Scholar
36.Graves, N. Economics and preventing hospital-acquired infection. Emerg Infect Dis 2004;10:561–566.Google Scholar
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;30:145–152.Google Scholar
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;71:27797–27939.Google Scholar
39.Revised ICD-9-CMDRG Definitions Manual, Version 18.0. 18th ed. Murray, UT: 3M Health Information Systems; 2002.Google Scholar
40.Farber, BF. Reimbursement for nosocomial infections under the prospective payment plan: the future or decline of infection control? Infect Control 1984;5:425–426.Google Scholar
41.Boyce, JM, Dziobek, L, Potter-Bynoe, G. Reimbursement for nosocomial infections. Ann Intern Med 1988;108:776.Google Scholar
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;257:1611–1614.CrossRefGoogle ScholarPubMed
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;121:182–205.Google Scholar
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;54:1013–1016.Google Scholar
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;125:2224–2231.Google Scholar
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;25:481–488.Google Scholar