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The Cost of Selected Tuberculosis Control Measures at Hospitals with a History of Mycobacterium Tuberculosis Outbreaks

Published online by Cambridge University Press:  02 January 2015

Scott Kellerman ,
Jerome I. Tokars  and
William R. Jarvis
Scott Kellerman*
Affiliation:
Investigation and Prevention Branch, Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Jerome I. Tokars
Affiliation:
Investigation and Prevention Branch, Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
William R. Jarvis
Affiliation:
Investigation and Prevention Branch, Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Hospital Infections Program, Centers for Disease Control and Prevention, Mailstop E-69, Atlanta, GA 30333
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Abstract

Objective:

To determine the cost of nonrespirator-related tuberculosis (TB) control measures at several hospitals, following publication of the Centers for Disease Control and Prevention (CDC)'s revised TB infection control guidelines.

Design:

Infection control (IC) and TB coordinators obtained cost information on tuberculin skin-test (TST) programs, addition of IC and employee health service (EHS) personnel, and the retrofit or new construction of environmental controls.

Setting:

Four hospitals with, and one community hospital without, prior nosocomial multidrug-resistant TB transmission.

Results:

During the study period, the TST program costs remained constant at four of five hospitals and increased at one hospital (median 1994 TST program cost: $5,568; range, $2,393-$44,902). Additional IC or EHS personnel were hired at four of five hospitals (median cost increase, $125,500; range, $63,000-$228,000). The median cost of new construction or new equipment purchases (ie, sputum induction booths, ultraviolet lights, or portable high-efficiency particulate air filters) at study hospitals was $163,000 (range, $45,000-$524,000) and $70,000 (range, $31,000-$93,000), respectively.

Conclusions:

Costs associated with implementing control measures similar to those recommended in the CDC TB IC guidelines varied widely by hospital. Engineering controls involved the largest capital outlay, but increases in personnel were the largest continuing cost. These costs represent improvements made to upgrade selected aspects of hospital TB control programs, not the cost of an optimal TB control program.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 8 , August 1997 , pp. 542 - 547
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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References

1. Rosenblum, LS, Castro, KG, Dooley, S, Morgan, M. Effect of HIV infection and tuberculosis on hospitalizations and cost of care for young adults in the United States, 1985 to 1990. Ann Intern Med 1994;121:786–792.Google Scholar
2. Arno, PS, Murray, CJL, Bonuck, KA, Alcabes, P. The economic impact of tuberculosis in hospitals in New York City: a preliminary analysis. J Law Med Ethics 1993;21:317–323.Google Scholar
3. Shulkin, DJ, Brennan, PJ. The cost of caring for patients with tuberculosis: planning for a disease on the rise. Am J Infect Control 1995;23:1–4.Google Scholar
4. Battelle Medical Technology Assessment and Policy (MEDTAP) Research Center. Estimate of identifiable direct costs of tuberculosis in the United States in 1991. Report prepared for Centers for Disease Control and Prevention. 07 1993.Google Scholar
5. Brown, RE, Miller, B, Taylor, WR, Palmer, C, Bosco, L, Nicola, RM. Health-care expenditures for tuberculosis in the United States. Arch Intern Med 1995;155:1595–1600.CrossRefGoogle ScholarPubMed
6. Silber, P, Alexander, WJ, Harden, JW, Housch, JG, Cutter, GR, Maetz, HM. A study of the cost of tuberculosis contact investigation related to non-tuberculosis mycobacterial isolation in Jefferson County, Alabama. Public Health 1987;101:297–304.Google Scholar
7. Raad, I, Cusick, J, Sherertz, RJ, et al. Annual tuberculin skin testing of employees at a university hospital: a cost-benefit analysis. Infect Control Hosp Epidemiol 1989;10:465–469.Google Scholar
8. Chinh, TL. Cost-effectiveness of the two-step skin test for tuberculosis screening of employees in a community hospital. Infect Control 1984;5:570–572.Google Scholar
9. CDC Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994. MMWR 1994;43(RR-13).Google Scholar
10. Edlin, BR, Tokars, JI, Grieco, MH, et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med 1992;326:1514–1521.Google Scholar
11. Pearson, ML, Jereb, JA, Frieden, TR, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis; a risk to patients and health care workers. Ann Intern Med 1992;117:191–196.Google Scholar
12. Beck-Sague, C, Dooley, SW, Huton, MD, et al. Hospital outbreaks of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients. JAMA 1992;268:1280–1286.Google Scholar
13. Jereb, JA, Klevens, M, Privett, TD, et al. Tuberculosis in health care workers at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis . Arch Intern Med 1995;155:854–859.Google Scholar
14. Wenger, PN, Otten, J, Breeden, A, Orfas, D, Beck-Sague, CM, Jarvis, WJ. Control of nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis among healthcare workers and HIV-infected patients. Lancet 1995;345:235–240.Google Scholar
15. Stroud, LA, Tokars, JI, Grieco, MH, et al. Evaluation of infection control measures in preventing the nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis in a New York City hospital. Infect Control Hosp Epidemiol 1995;16:141–147.Google Scholar
16. Maloney, SA, Pearson, ML, Gordon, MT, Del Castillo, R, Boyle, JF, Jarvis, WR. Efficacy of control measures in preventing nosocomial transmission of multidrug-resistant tuberculosis to patients and health care workers. Ann Intern Med 1995;122:90–95.Google Scholar
17. Fridkin, SK, Manangan, L, Bolyard, E. SHEA-CDC TB survey, part I: status of TB infection control programs at member hospitals, 1989-1992. Infect Control Hosp Epidemiol 1995;16:129–134.CrossRefGoogle ScholarPubMed
18. Fridkin, SK, Manangan, L, Bolyard, E. SHEA-CDC TB survey, part II: efficacy of TB infection control programs at member hospitals, 1992. Infect Control Hosp Epidemiol 1995;16:135–140.Google Scholar
19. Snider, DE, Caras, GJ, Koplan, JP. Preventive therapy with isoniazid: cost-effectiveness of different durations of therapy. JAMA 1986;255:1579–1583.Google Scholar
20. Dunlap, NE, Kimerling, ME. Drug-resistant tuberculosis in adults: implications for the health care worker. Infect Agents Dis 1994;3:245–255.Google Scholar