Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-22T04:27:22.082Z Has data issue: false hasContentIssue false
  • English
  • Français

Costs of Management of Occupational Exposures to Blood and Body Fluids

Published online by Cambridge University Press:  02 January 2015

Emily M. O'Malley ,
R. Douglas Scott II ,
Julie Gayle ,
John Dekutoski ,
Michael Foltzer ,
Tammy S. Lundstrom ,
Sharon Welbel ,
Linda A. Chiarello  and
Adelisa L. Panlilio
Emily M. O'Malley
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Center for Health Outcomes and Quality, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
R. Douglas Scott II
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Julie Gayle
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia
John Dekutoski
Affiliation:
Department of Veterans Affairs Medical Center, San Francisco, California
Michael Foltzer
Affiliation:
Geisinger Medical Center, Danville, Pennsylvania
Tammy S. Lundstrom
Affiliation:
Detroit Medical Center, Detroit, Michigan
Sharon Welbel
Affiliation:
John H. Stroger Hospital of Cook County and Rush Medical College, Chicago, Illinois
Linda A. Chiarello
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Adelisa L. Panlilio*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop A-31, Atlanta, GA 30333 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine the cost of management of occupational exposures to blood and body fluids.

Design.

A convenience sample of 4 healthcare facilities provided information on the cost of management of occupational exposures that varied in type, severity, and exposure source infection status. Detailed information was collected on time spent reporting, managing, and following up the exposures; salaries (including benefits) for representative staff who sustained and who managed exposures; and costs (not charges) for laboratory testing of exposure sources and exposed healthcare personnel, as well as any postexposure prophylaxis taken by the exposed personnel. Resources used were stratified by the phase of exposure management: exposure reporting, initial management, and follow-up. Data for 31 exposure scenarios were analyzed. Costs were given in 2003 US dollars.

Setting.

The 4 facilities providing data were a 600-bed public hospital, a 244-bed Veterans Affairs medical center, a 437-bed rural tertiary care hospital, and a 3,500-bed healthcare system.

Results.

The overall range of costs to manage reported exposures was $71-$4,838. Mean total costs varied greatly by the infection status of the source patient. The overall mean cost for exposures to human immunodeficiency virus (HIV)-infected source patients (n = 19, including those coinfected with hepatitis B or C virus) was $2,456 (range, $907-$4,838), whereas the overall mean cost for exposures to source patients with unknown or negative infection status (n = 8) was $376 (range, $71-$860). Lastly, the overall mean cost of management of reported exposures for source patients infected with hepatitis C virus (n = 4) was $650 (range, $186-$856).

Conclusions.

Management of occupational exposures to blood and body fluids is costly, the best way to avoid these costs is by prevention of exposures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 7 , July 2007 , pp. 774 - 782
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Beltrami, EM, Williams, IT, Shapiro, CN, Chamberland, ME. Risk and management of bloodborne infections in health care workers, Clin Micro Rev 2000;13:385–407.Google Scholar
2.Panlilio, AL, Orelien, JG, Srivastava, PU, et al.Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998. Infect Control Hosp Epidemiol 2004;25:556–562.Google Scholar
3.Panlilio, AL, Foy, DR, Edwards, JR, et al.Blood contacts during surgical procedures. JAMA 1991;265:1533–1537.Google Scholar
4.Gerberding, JL, Litteil, C, Tarkington, A, et al.Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital. N Engl J Med 1990;322:1788–1793.Google Scholar
5.Tokars, JI, Bell, DM, Culver, DH, et al.Percutaneous injuries during surgical procedures. JAMA 1992;267:2899–2904.Google Scholar
6.Tokars, JI, Culver, DH, Mendelson, MH, et al.Skin and mucous membrane contacts with blood during surgical procedures: risk and prevention. Infect Control Hosp Epidemiol 1995;16:703–711.Google Scholar
7.Wright, JG, McGeer, AJ, Chyatte, D, Ransohoff, DF. Exposure rates to patients' blood for surgical personnel. Surgery 1993;114:897–901.Google Scholar
8.Shapiro, CN. Occupational risk of infection with hepatitis B virus and hepatitis C virus. Surg Clin N Am 1995;75:1047–1056.Google Scholar
9.Bell, DM. Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview. Am J Med 1997;102(suppl 5B):9–15.Google Scholar
10.Jagger, J, De Carli, G, Perry, J, Puro, V, Ippolito, G. Occupational exposure to bloodborne pathogens: epidemiology and prevention. In: Wenzel, R, ed. Prevention and Control of Nosocomial Infections. 4th ed. Baltimore: Lippincott, Williams and Wilkins; 2003.Google Scholar
11.Centers for Disease Control and Prevention. Recommendation for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR Recomm Rep 1998;47(RR-19):1–39.Google Scholar
12.Jagger, J, Puro, V, De Carli, G. Occupational transmission of hepatitis C virus. JAMA 2002;288:1469.Google Scholar
13.Mitsui, T, Iwano, K, Masuko, K, et al.Hepatitis C infection in medical personnel after needlestick accident. Hepatology 1992;16:1109.Google Scholar
14.Centers for Disease Control and Prevention. Recommendations for preventing transmission of infection with human T-lymphotropic virus type III/lymphadenopathy-associated virus in the workplace. MMWR Morb Mortal Wkly Rep 1985;34:681–686,691-695.Google Scholar
15.Centers for Disease Control and Prevention. Updated US Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2001;50(RR-11):1–52.Google Scholar
16.Centers for Disease Control and Prevention. Updated US Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2005;54(RR-9):1–17.Google Scholar
17.Armstrong, K, Gorden, R, Santorella, G. Occupational exposure of health care workers (HCWs) to human immunodeficiency virus (HIV): stress reactions and counseling interventions. Soc Work Health Care 1995;21:61–80.Google Scholar
18.Meienberg, F, Bucher, HC, Sponagel, L, Zinkernagel, C, Gyr, N, Battegay, M. Anxiety in health care workers after exposure to potentially HIV-contaminated blood or body fluids. Swiss Med Wkly 2002;132:321–324.Google Scholar
19.Ruben, FL, Norden, CW, Rockwell, K, Hruska, E. Epidemiology of accidental needle-puncture wounds in hospital workers. Am J Med Sci 1983;286:26–30.Google Scholar
20.Jagger, J, Hunt, EH. Rates of needlestick injury caused by various devices in a university hospital. N Engl J Med 1988;319:284–288.Google Scholar
21.Jagger, J, Hunt, EH, Pearson, RD. Estimated cost of needlestick injuries for 6 major needled devices. Infect Control Hosp Epidemiol 1990;11:584–588.Google Scholar
22.McCormick, RD, Meisch, MG, Ircink, FG, Mak, DG. Epidemiology of sharps injuries: a 14-year prospective study in the pre-AIDS and AIDS eras. Am J Med 1991;91(suppl 3B):301S–307S.Google Scholar
23.Sellick, JA, Hazamy, PA, Mylotte, JM. Influence of an educational program and mechanical opening needle disposal boxes on occupational needlestick injuries. Infect Control Hosp Epidemiol 1991;12:725–731.Google Scholar
24.Orenstein, R, Reynolds, L, Karabaic, M, Lamb, A, Markowitz, SM, Wong, ES. Do protective devices prevent needlestick injuries among health care workers? Am J Infect Control 1995;23:344–351.Google Scholar
25.Friedland, LR, Kulick, RM, Biro, FM, Patterson, A. Cost-effectiveness decision analysis of intramuscular ceftriaxone versus oral Cefixime in adolescents with gonococcal cervicitis. Ann Emerg Med 1996;27:299–304.Google Scholar
26.Pinkerton, SD, Holtgrave, DR. Cost-effectiveness of chemoprophylaxis after occupational exposure to HIV. Arch Intern Med 1997;157:1972–1981.Google Scholar
27.Dale, JC, Pruett, SK, Maker, MD. Accidental needlesticks in the phlebotomy service of the department of laboratory. Mayo Clin Proc 1998;73:611–615.Google Scholar
28.Jagger, J, Bentley, M, Juillet, E. Direct cost of follow-up for percutaneous and mucocutaneous exposures to at-risk body fluids: data from two hospitals. Adv Expos Prev 1998;3:25–34.Google Scholar
29.Mendelson, MH, Short, LJ, Schechter, CB, et al.Study of needleless intermittent intravenous-access system for peripheral infusions: analysis of staff, patient, and institutional outcomes. Infect Control Hosp Epidemiol 1998;19:401–406.Google Scholar
30.Swotinsky, RB, Steger, KA, Sulis, C, Snyder, S, Craven, DE. Occupational exposure to HIV: experience at a tertiary care center. J Occup Environ Med 1998;40:1102–1109.Google Scholar
31.Roudot-Thoraval, F, Montagne, O. Costs and benefits measure to prevent needlestick injuries in a university hospital. Infect Control Hosp Epidemiol 1999;20:614–617.Google Scholar
32.Kallenborn, JC, Price, TG, Carrico, R, Davidson, AB. Emergency department management of occupational exposures: cost analysis of rapid HIV test. Infect Control Hosp Epidemiol 2001;22:289–293.Google Scholar
33.Laufer, FN, Chiarello, LA. Application of cost-effectiveness methodology to the consideration of needlestick-preventton technology. Am J Infect Control 1994;22:75–82.Google Scholar
34.Dziekan, G, Chisolm, D, Johns, B, Rovira, J, Hutin, YJF. The cost-effectiveness of policies for the safe and appropriate use of injection in healthcare settings. Bull WHO 2003;81:277–285.Google Scholar
35.Holodnick, CL, Barkauskas, V. Reducing percutaneous injuries in the OR by educational methods. AORN J 2000;72:461–464,468-772, 475-476.Google Scholar
36.Lee, JM, Botteman, MF, Xanthakos, N, Nicklasson, L. Needlestick injuries in the United States: epidemiologic, economic, and quality of life issues. AAOHN J 2005;53:117–133.Google Scholar
37.Siekman, P. Becton Dickinson takes a plunge with safer needles: by gearing up to make devices like these, the company giving its profits a shot in the arm. Fortune 2001;144:157–168.Google Scholar
38.Kelly, D. Trends in US patents for needlestick prevention technology. Adv Expos Prev 1996;2:7–8.Google Scholar
39.Farnham, PG, Haddix, AC. Study Design. In: Haddix, AC, Teutsch, SM, Shaffer, PA, Dunet, DO, eds. Prevention Effectiveness: A Guide to Decision Analysis and Economic Evaluation. 2nd ed. New York: Oxford University Press; 2003:11–27.Google Scholar