Cost and Cost Benefit of Infection Control

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Cost and Cost Benefit of Infection Control

• William A. Rutala, Ph.D., M.P.H.
• David J. Weber, M.D., M.P.H.
• Hospital Epidemiology, UNC Health Care System

December 2005
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Topics

• Minimal IC Program staffing
• 1 ICP 150 adjusted occupied beds
• Mandatory CBIC certification
• Legislative bill, that the Health Commission
  adopt rules to establish staff qualifications
  including professional requirements for hospital
  staff, did not pass

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Healthcare-Associated Infections (HAIs)

• HAIs are those that develop in the hospital that
  were neither incubating nor present at the time
  of admission
• 40 million persons hospitalized annually in US
  5 or 2 million will develop a HAI
• Morbidity and mortality (90,000 deaths)
• Variable prolongation of hospital stay
• Total annual hospital-related financial
  burden-6.5 billion

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Cost of Infection Control

• Cost of infection control borne by hospitals
• Under modern payment systems, hospitals reap the
  financial benefits associated with decreased HAI
• Fixed reimbursement based on diagnosis transfers
  the risk from payer to hospital
• Complications that slow discharge and consume
  resources are only partially reimbursed at best
• Thus, HAIs cost hospitals money

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Cost of Infection Control

• In addition to the economic incentive, hospitals
  have a fiduciary charge to provide high-quality
  patient care
• To the extent, HAIs are preventable, HAIs
  represent defects in patient care
• Thus, infection control is in the enviable
  position of saving money while simultaneously
  improving the quality of care

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Cost of Infection Control

• Against this background, many infection control
  programs are neither well funded nor highly
  valued in their institutions
• Savings due to averted infections are often
  poorly understood or ignored

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Cost of Infection Control

• Another problem is that infection control
  programs are not standardized
• A survey of 45 university-affiliated hospitals
  showed a median of 1 ICP per 137 beds
• NNIS hospitals have 1 ICP per 123 beds
• 0.8-1.0 ICP for every 100 beds suggested by
  Delphi panel
• High quality IC programs require substantial time
  to review reports, conduct surveillance, educate
  staff, evaluate outbreaks, participate in
  committees, ensure that regulatory requirements
  are met, and most importantly, prevent HAIs.

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Cost of Healthcare-Associated Infections
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Costs of an Infection Control Program300-Bed
Hospital
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Cost-Benefit Assessment of Infection Control
Programs

• SENIC found that 32 of HAIs can be prevented by
  effective infection control programs
• Hospitals without effective programs actually had
  a rise in HAIs from 9 to 31, but effective
  programs reduced HAI rates from 7 to 48 in the
  same period
• Based on SENIC findings, a hypothetical hospital
  would have 713 infections/year without an
  effective program but 487 infections with an
  effective program

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Cost-Benefit Assessment of Infection Control
Programs

• An effective program would save the hospital
  about 900,000 annually
• This projection uses very conservative estimates
  of the excess costs resulting from HAIs
• The infection control program costs for a 250-bed
  hospital would be less than 250,000
• Preventing HAIs is cost-beneficial with an
  estimated savings of 650,000 annually

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Cost Per Year of Life Saved
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New Frontiers

• Emphasis on patient safety
• Lack of treatment for new pathogens (e.g., SARS)
• Move from inpatient to outpatient environment
• Increase in population age
• Persons gt65yo numbered 36 million in 2004 and by
  2030 there will be 72 million
• Increase in antimicrobial resistance (e.g., MRSA)

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Traditional ICP Activities

• Surveillance
• Outbreak investigations
• Policy development and implementation
• Environmental/infection control rounds
• Education (infection control, bloodborne
  pathogen, TB)
• Regulatory compliance
• Committee participation

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New ICP Responsibilities

• Increased regulations (OSHA, FDA)
• Emerging pathogens (avian influenza)
• IHI campaign
• Increase training/education requirements
• Post-exposure prophylaxis (HIV, HBV)
• Epidemiologic typing of outbreak pathogens
• Interpreting screening cultures (MRSA, VRE)
• Risk adjusted surveillance (SSI, CR-BSI, VAP)
• Sentinel event analysis

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Summary

• Increase infection control resources are a
  win-win-win investment
• Reduced patient morbidity and mortality
• Net cost savings to institution, society and
  patient
• Improve patient satisfaction
• From the standpoint of the hospital and society,
  the benefits exceed the costs
• Hospitals should support a ratio of ICP per beds
  of 1150

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Thank you
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References

• Nettlemen MD. Cost and cost benefit of infection
  control. In Wenzel RP. Prevention and Control of
  Nosocomial Infections, 2003
• Dixon RE. Cost of nosocomial infections and
  benefits of infection control programs. In Wenzel
  RP. Prevention and Control of Nosocomial
  Infections, 1987
• Wenzel RP. The economics of nosocomial
  infections. J Hosp Infect 19953179
• Burke JP. Infection control-A problem for patient
  safety. NEJM 20033487.
• OBoyle C. et al. Am J Infect Control 2002
  30321