Cost and Cost Benefit of Infection Control.ppt

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,December 2005,Topics,Minimal IC Program staffing 1 ICP 150 adjusted occupied beds Mandatory CBIC certification Legislative bill, that the Health Comm

2、ission adopt rules to establish staff qualifications including professional requirements for hospital staff, did not pass,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 hospitali

3、zed 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,Cost of Infection Control,Cost of infection control borne by hospitals Under modern payment systems, hospi

4、tals 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,Cost of Infection Control,In a

5、ddition 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,Cost of Infection Control,Another problem is that infection control programs ar

7、e 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 s

8、taff, evaluate outbreaks, participate in committees, ensure that regulatory requirements are met, and most importantly, prevent HAIs.,Cost of Healthcare-Associated Infections,Costs of an Infection Control Program300-Bed Hospital,Cost-Benefit Assessment of Infection Control Programs,SENIC found that

9、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/ye

10、ar without an effective program but 487 infections with an effective program,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 infecti

11、on 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,Cost Per Year of Life Saved,New Frontiers,Emphasis on patient safety Lack of treatment for new pathogens (e.g., SARS) Move from inpatient to o

12、utpatient 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),Traditional ICP Activities,Surveillance Outbreak investigations Policy development and implementation Environmental/infecti

13、on control rounds Education (infection control, bloodborne pathogen, TB) Regulatory compliance Committee participation,New ICP Responsibilities,Increased regulations (OSHA, FDA) Emerging pathogens (avian influenza) IHI campaign Increase training/education requirements Post-exposure prophylaxis (HIV,

14、 HBV) Epidemiologic typing of outbreak pathogens Interpreting screening cultures (MRSA, VRE) Risk adjusted surveillance (SSI, CR-BSI, VAP) Sentinel event analysis,Summary,Increase infection control resources are a win-win-win investment Reduced patient morbidity and mortality Net cost savings to ins

15、titution, 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,Thank you,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