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Cost and Cost Benefit of Infection Control

Topics. Minimal IC Program staffing1 ICP 150 adjusted occupied bedsMandatory CBIC certificationLegislative bill, that the Health Commission adopt rules to establish staff qualifications including professional requirements for hospital staff, did not pass . Healthcare-Associated Infections (HAIs).

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Cost and Cost Benefit of Infection Control

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    1. 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

    3. 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

    4. 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

    5. 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

    6. 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

    7. 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.

    8. Cost of Healthcare-Associated Infections

    9. Costs of an Infection Control Program 300-Bed Hospital

    10. 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

    11. 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

    12. Cost Per Year of Life Saved

    13. 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 >65yo numbered 36 million in 2004 and by 2030 there will be 72 million Increase in antimicrobial resistance (e.g., MRSA)

    14. Traditional ICP Activities Surveillance Outbreak investigations Policy development and implementation Environmental/infection control rounds Education (infection control, bloodborne pathogen, TB) Regulatory compliance Committee participation

    15. 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

    16. 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 1:150

    17. Thank you

    18. 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 1995;31:79 Burke JP. Infection control-A problem for patient safety. NEJM 2003;348:7. O’Boyle C. et al. Am J Infect Control 2002; 30:321

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