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1.
Ann Glob Health ; 86(1): 16, 2020 02 13.
Article in English | MEDLINE | ID: mdl-32090023

ABSTRACT

Introduction: A clean and functional microscope is necessary for accurate diagnosis of infectious diseases. In tropical climates, high humidity levels and improper storage conditions allow for the accumulation of debris and fungus on the optical components of diagnostic equipment, such as microscopes. Objective: Our objective was to develop and implement a low-cost, sustainable, easy to manage, low-maintenance, passive humidity control chamber to both reduce debris accumulation and microbial growth onto the optical components of microscopes. Methods: Constructed from easily-sourced and locally available materials, the cost of each humidity control chamber is approximately $2.35 USD. Relative humidity levels were recorded every 30 minutes over a period of 10 weeks from two chambers deployed at the Belize Vector and Ecology Center and the University of Belize. Results: The humidity control chamber deployed at the University of Belize maintained internal relative humidity at an average of 35.3% (SD = 4.2%) over 10 weeks, while the average external relative humidity was 86.4% (SD = 12.4%). The humidity control chamber deployed at the Belize Vector and Ecology Center effectively maintained internal relative humidity to an average of 54.5% (SD = 9.4%) over 10 weeks, while the average external relative humidity was 86.9% (SD = 12.9%). Conclusions: Control of relative humidity is paramount for the sustainability of medical equipment in tropical climates. The humidity control chambers reduced relative humidity to levels that were not conducive for fungal growth while reducing microscope contamination from external sources. This will likely extend the service life of the microscopes while taking advantage of low-cost, locally sourced components.


Subject(s)
Humidity/prevention & control , Hygroscopic Agents , Microscopy/instrumentation , Tropical Climate , Belize , Costs and Cost Analysis , Equipment Contamination/economics , Equipment Contamination/prevention & control , Equipment and Supplies , Fungi/growth & development , Humans , Humidity/adverse effects , Hygroscopic Agents/economics , Microscopy/economics , Silicon Dioxide/economics
3.
Am J Infect Control ; 47(8): 963-967, 2019 08.
Article in English | MEDLINE | ID: mdl-30795840

ABSTRACT

BACKGROUND: Blood culture contamination with gram-positive organisms is a common occurrence in patients suspected of bloodstream infections, especially in emergency departments. Although numerous research studies have investigated the cost implications of blood culture contamination, a contemporary systematic review of the literature has not been performed. The aim of this project was to perform a systematic review of the published literature on the economic costs of blood culture contamination. METHODS: PubMed was searched (January 1, 1978, to July 15, 2018) using the search terms "blood culture contamination" or "false-positive blood cultures." Articles were title searched and abstracts were reviewed for eligible articles that reported immediate or downstream economic costs of blood culture contamination. RESULTS AND DISCUSSION: The PubMed search identified 151 relevant articles by title search, with 49 articles included after abstract review. From the studies included, overall blood culture contamination rates ranged from 0.9%-41%. Up to 59% of patients received unnecessary treatment with parenteral vancomycin as a result of blood culture contamination, resulting in increased pharmacy charges between $210 and $12,611 per patient. Increases in total laboratory charges between $2,397 and $11,152 per patient were reported. Attributable hospital length of stay increases due to blood culture contamination ranged from 1-22 days. CONCLUSIONS: This systematic review of the literature identified several areas of health care expenditure associated with blood culture contamination. Interventions to reduce the risk of blood culture contamination would avoid downstream economic costs.


Subject(s)
Blood Culture/economics , Blood Culture/standards , Gram-Positive Bacteria/isolation & purification , Health Care Costs , Equipment Contamination/economics , Health Expenditures , Humans
4.
Anesth Analg ; 129(1): 74-83, 2019 07.
Article in English | MEDLINE | ID: mdl-29847377

ABSTRACT

BACKGROUND: The objective of this study was to assess the efficacy and cost of Malignant Hyperthermia Association of the United States-recommended methods for preparing Dräger Zeus anesthesia workstations (AWSs) for the malignant hyperthermia-susceptible patient. METHODS: We studied washout profiles of sevoflurane, isoflurane, and desflurane in 3 Zeus AWS following 3 preparation methods. AWS was primed with 1.2 minimum alveolar concentration anesthetic for 2 hours using 2 L/min fresh gas flow, 500 mL tidal volume, and 12/min respiratory rate. Two phases of washout were performed: high flow (10 L/min) until anesthetic concentration was <5 parts per million (ppm) for 20 minutes and then low flow (3 L/min) for 20 minutes to identify the rebound effect. Preparation methods are as follows: method 1 (M1), changing disposables (breathing circuit, soda lime, CO2 line, and water traps); method 2 (M2), M1 plus replacing the breathing system with an autoclaved one; and method 3 (M3), M1 plus mounting 2 activated charcoal filters on respiratory limbs. Primary outcomes are as follows: time to obtain anesthetic concentration <5 ppm in the high-flow phase, peak anesthetic concentrations in the low-flow phase, and for M3 only, peak anesthetic concentration after 70 minutes of low-flow phase, when activated charcoal filters are removed. Secondary outcomes are as follows: cost analysis of time and resources to obtain anesthetic concentration <5 ppm in each method and a vapor-free Zeus AWS. Sensitivity analyses were performed using alternative assumptions regarding the costs and the malignant hyperthermia-susceptible caseload per year. RESULTS: Primary outcomes were as follows: M3 instantaneously decreased anesthetic concentration to <1 ppm with minimal impact of low-flow phase. M1 (median, 88 minutes; 95% confidence interval [CI], 69-112 minutes) was greater than M2 (median, 11 minutes; 95% CI, 9-15 minutes). Means of peak rebound anesthetic concentrations in M1, M2, and M3 were 15, 6, and 1 ppm, respectively (P < .001). Anesthetic concentration increased 33-fold (95% CI, 21-50) after removing charcoal filters (from 0.7 to 20 ppm). The choice of anesthetic agents did not impact the results. Secondary outcomes were as follows: M3 was the lowest cost when the cost of lost operating room (OR) time due to washout was included, and M1 was the lowest cost when it was not included. When the cost of lost OR time due to washout was considered the estimated cost/case of M3 was US $360 (M1, US $2670; M2, US $969; and a "vapor-free" Zeus AWS was US $930). The OR time and equipment costs represent the largest differentiators among the methods. CONCLUSIONS: Institutions in which demand for OR time has exceeded capacity should consider M3, and institutions with surplus OR capacity should consider M1.


Subject(s)
Anesthesia, Inhalation/instrumentation , Anesthetics, Inhalation/administration & dosage , Charcoal , Decontamination/methods , Equipment Contamination/prevention & control , Malignant Hyperthermia/prevention & control , Ventilators, Mechanical , Administration, Inhalation , Anesthesia, Inhalation/adverse effects , Anesthesia, Inhalation/economics , Anesthetics, Inhalation/adverse effects , Anesthetics, Inhalation/economics , Charcoal/economics , Decontamination/economics , Equipment Contamination/economics , Equipment Design , Hospital Costs , Humans , Malignant Hyperthermia/economics , Malignant Hyperthermia/etiology , Malignant Hyperthermia/physiopathology , Risk Assessment , Risk Factors , Time Factors
5.
J Clin Microbiol ; 57(1)2019 01.
Article in English | MEDLINE | ID: mdl-30355758

ABSTRACT

Blood culture contamination results in increased hospital costs and exposure to antimicrobials. We evaluated the potential clinical and economic benefits of an initial specimen diversion device (ISDD) when routinely utilized for blood culture collection in the emergency department (ED) of a quaternary care medical center. A decision analysis model was created to identify the cost benefit of the use of the ISDD device in the ED. Probabilistic costs were determined from the published literature and the direct observation of pharmacy/microbiology staff. The primary outcome was the expected per-patient cost savings (microbiology, pharmacy, and indirect hospital costs) with the routine use of an ISDD from a hospital perspective. The indirect costs included those related to an increased hospital length of stay, additional procedures, adverse drug reactions, and hospital-acquired infections. Models were created to represent hospitals that routinely or do not routinely use rapid diagnostic tests (RDT) on positive blood cultures. The routine implementation of ISDD for blood culture collection in the ED was cost beneficial compared to conventional blood culture collection methods. When implemented in a hospital utilizing RDT with a baseline contamination rate of 6%, ISDD use was associated with a cost savings of $272 (3%) per blood culture in terms of overall hospital costs and $28 (5.4%) in direct-only costs. The main drivers of cost were baseline contamination rates and the duration of antibiotics given to patients with negative blood cultures. These findings support the routine use of ISDD during blood culture collection in the ED as a cost-beneficial strategy to reduce the clinical and economic impact of blood culture contamination in terms of microbiology, pharmacy, and wider indirect hospital impacts.


Subject(s)
Blood Culture/methods , Blood Specimen Collection/instrumentation , Cost-Benefit Analysis , Diagnostic Errors/prevention & control , Emergency Service, Hospital/economics , Equipment Contamination/prevention & control , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Cost Savings/economics , Cross Infection/economics , Cross Infection/prevention & control , Decision Support Techniques , Equipment Contamination/economics , Hospital Costs , Humans
6.
Stereotact Funct Neurosurg ; 95(2): 117-124, 2017.
Article in English | MEDLINE | ID: mdl-28395278

ABSTRACT

BACKGROUND: Deep brain stimulation (DBS) hardware infection is a serious complication, often resulting in multiple hardware salvage attempts, hospitalizations, and long-term antibiotic therapy. OBJECTIVES: We aimed to quantify the costs of DBS hardware-related infections in patients undergoing eventual device explantation. METHODS: Of 362 patients who underwent 530 electrode placements (1 January 2010 to 30 December 2014), 16 (4.4%) had at least 2 hardware salvage procedures. Most (n = 15 [93.8%]) required complete explantation due to recurrent infection. Financial data (itemized hospital and physician costs) were available for 13 patients and these were analyzed along with the demographic data. RESULTS: Each patient underwent 1-5 salvage procedures (mean 2.5 ± 1.4; median 2). The mean total cost for a patient undergoing the median number of revisions (n = 2), device explantation, and subsequent reimplantation after infection clearance was USD 75,505; just over half this cost (54.2% [USD 40,960]) was attributable to reimplantation, and nearly one-third (28.9% [USD 21,816]) was attributable to hardware salvage procedures. Operating-room costs were the highest cost category for hardware revision and explantation. Medical and surgical supplies accounted for the highest reimplantation cost. CONCLUSIONS: DBS infection incurs significant health care costs associated with hardware salvage attempts, explantation, and reimplantation. The highest cost categories are operating-room services and medical and surgical supplies.


Subject(s)
Deep Brain Stimulation/adverse effects , Deep Brain Stimulation/economics , Device Removal/economics , Equipment Contamination/economics , Hospital Costs , Reoperation/economics , Adult , Aged , Device Removal/trends , Female , Hospital Costs/trends , Humans , Male , Middle Aged , Postoperative Complications/economics , Postoperative Complications/surgery , Reoperation/trends , Young Adult
7.
Clin Infect Dis ; 65(2): 201-205, 2017 Jul 15.
Article in English | MEDLINE | ID: mdl-28379370

ABSTRACT

BACKGROUND: Blood culture contamination is a clinically significant problem that results in patient harm and excess cost. METHODS: In a prospective, controlled trial at an academic center Emergency Department, a device that diverts and sequesters the initial 1.5-2 mL portion of blood (which presumably carries contaminating skin cells and microbes) was tested against standard phlebotomy procedures in patients requiring blood cultures due to clinical suspicion of serious infection. RESULTS: In sum, 971 subjects granted informed consent and were enrolled resulting in 904 nonduplicative subjects with 1808 blood cultures. Blood culture contamination was significantly reduced through use of the initial specimen diversion device™ (ISDD) compared to standard procedure: (2/904 [0.22%] ISDD vs 16/904 [1.78%] standard practice, P = .001). Sensitivity was not compromised: true bacteremia was noted in 65/904 (7.2%) ISDD vs 69/904 (7.6%) standard procedure, P = .41. No needlestick injuries or potential bloodborne pathogen exposures were reported. The monthly rate of blood culture contamination for all nurse-drawn and phlebotomist-drawn blood cultures was modeled using Poisson regression to compare the 12-month intervention period to the 6 month before and after periods. Phlebotomists (used the ISDD) experienced a significant decrease in blood culture contamination while the nurses (did not use the ISDD) did not. In sum, 73% of phlebotomists completed a post-study anonymous survey and widespread user satisfaction was noted. CONCLUSIONS: Use of the ISDD was associated with a significant decrease in blood culture contamination in patients undergoing blood cultures in an Emergency Department setting. CLINICAL TRIALS REGISTRATION: NCT02102087.


Subject(s)
Blood Culture/methods , Blood Specimen Collection/instrumentation , Equipment Contamination/prevention & control , Phlebotomy/methods , Bacteremia/microbiology , Blood Specimen Collection/methods , Costs and Cost Analysis , Emergency Service, Hospital , Enterobacteriaceae/isolation & purification , Equipment Contamination/economics , Female , Humans , Male , Phlebotomy/instrumentation , Prospective Studies
8.
J Cardiovasc Electrophysiol ; 26(7): 783-9, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25845917

ABSTRACT

INTRODUCTION: Infection of cardiac implanted electrical devices (CIED) is a problem. In selected patients, use of an "antibacterial envelope" (AIGISRx®) is associated with low CIED infection rates. The value of this device when used as a standard of care is unclear. METHODS AND RESULTS: Retrospective analysis of all patients (N = 1,476) who underwent CIED implantation at a single hospital. During the study period, some implanters used the AIGISRx as a standard of care (Yes-AIGISRx Group, N = 365), whereas others did not use it at all (No-AIGISRx Group, N = 1,111). A risk score based on preoperative factors was calculated for each patient. Rates of CIED infection within 6 months were measured, and associated costs were estimated. The Yes-AIGISRx and No-AIGISRx groups had similar preoperative infection risk. In the No-AIGISRx group, 19 infections were observed (1.7%), versus 0 in the Yes-AIGISRx group (P = 0.006). The 6-month mortality rate among patients with infection was significantly greater than among those without infection (15.7% vs. 4.5%, P = 0.021). The average hospital duration for infection care was 13 days. By extrapolating the infection rate and costs observed in the No-AIGISRx group to the Yes-AIGISRx group, we estimated that there would have been 6.2 additional infections costing approximately $340,000. This cost was similar to the actual cost of the devices in the Yes-AIGISRx group, estimated at $320,000. CONCLUSIONS: Standard of care use of an antibacterial envelope as a standard of care was associated with a significantly lower rate of CIED infection, and appeared to be economically reasonable. Prospective trials to address these findings may be worthwhile.


Subject(s)
Defibrillators, Implantable/adverse effects , Equipment Contamination/prevention & control , Pacemaker, Artificial/adverse effects , Process Assessment, Health Care , Prosthesis-Related Infections/prevention & control , Aged , Aged, 80 and over , Cardiac Resynchronization Therapy Devices/adverse effects , Cardiac Resynchronization Therapy Devices/economics , Cost-Benefit Analysis , Defibrillators, Implantable/economics , Equipment Contamination/economics , Female , Health Care Costs , Health Services Research , Humans , Length of Stay , Male , Middle Aged , Pacemaker, Artificial/economics , Pennsylvania , Process Assessment, Health Care/economics , Prosthesis Design , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/economics , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/mortality , Retrospective Studies , Standard of Care , Tertiary Care Centers , Time Factors , Treatment Outcome
9.
Anaesthesia ; 69(4): 337-42, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24502257

ABSTRACT

In the presence of single-use airway filters, we quantified anaesthetic circuit aerobic microbial contamination rates when changed every 24 h, 48 h and 7 days. Microbiological samples were taken from the interior of 305 anaesthetic breathing circuits over a 15-month period (3197 operations). There was no significant difference in the proportion of contaminated circuits when changed every 24 h (57/105 (54%, 95% CI 45-64%)) compared with 48 h (43/100 (43%, 95% CI 33-53%, p = 0.12)) and up to 7 days (46/100 (46%, 95% CI 36-56%, p = 0.26)). Median bacterial counts were not increased at 48 h or 7 days provided circuits were routinely emptied of condensate. Annual savings for one hospital (six operating theatres) were $AU 5219 (£3079, €3654, $US 4846) and a 57% decrease in anaesthesia circuit steriliser loads associated with a yearly saving of 2760 kWh of electricity and 48 000 l of water. Our findings suggest that extended circuit use from 24 h up to 7 days does not significantly increase bacterial contamination, and is associated with labour, energy, water and financial savings.


Subject(s)
Airway Management/instrumentation , Anesthesia , Anesthesiology/instrumentation , Equipment Contamination/prevention & control , Equipment Reuse/standards , Hygiene/standards , Airway Management/economics , Anesthesiology/economics , Bacteria/growth & development , Bacterial Load , Costs and Cost Analysis , Cross Infection , Disinfection/standards , Electricity , Equipment Contamination/economics , Equipment Reuse/economics , Humans , Hygiene/economics , Prospective Studies , Sterilization/standards , Water Supply/economics
10.
Pediatrics ; 131(1): e292-7, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23209105

ABSTRACT

BACKGROUND AND OBJECTIVE: Blood culture contamination in the pediatric population remains a significant quality and safety issue because false-positive blood cultures lead to unnecessary use of resources and testing. In addition, few studies describe interventions to reduce peripheral blood culture contamination rates in this population. We hypothesized that the introduction of a standardized sterile collection process would reduce the pediatric emergency department's peripheral blood culture contamination rate and unnecessary use of resources. METHODS: A sterile blood culture collection process was designed by analyzing current practice and identifying areas in which sterile technique could be introduced. To spread the new technique, a web-based educational model was developed and disseminated. Subsequently, all nursing staff members were expected to perform peripheral blood cultures by using the modified sterile technique. RESULTS: The peripheral blood culture contamination rate was reduced from 3.9% during the baseline period to 1.6% during the intervention period (P < .0001), with yearly estimated savings of ~$250,000 in hospital charges. CONCLUSIONS: Subsequent to our intervention, there was a significant reduction of the peripheral blood culture contamination rate as well as considerable cost savings to the institution. When performed in a standardized fashion by using sterile technique, blood culture collection with low contamination rates can be performed via the insertion of an intravenous catheter.


Subject(s)
Blood Specimen Collection/economics , Cost Savings/economics , Emergency Medical Services/economics , Emergency Service, Hospital/economics , Blood Specimen Collection/methods , Blood Specimen Collection/standards , Catheterization, Peripheral/instrumentation , Catheterization, Peripheral/standards , Child , Child, Preschool , Cost Savings/methods , Cost Savings/standards , Emergency Medical Services/methods , Emergency Medical Services/standards , Emergency Service, Hospital/standards , Equipment Contamination/economics , Equipment Contamination/prevention & control , Female , Humans , Infant , Male , Retrospective Studies
12.
Lancet ; 380(9847): 1066-74, 2012 Sep 22.
Article in English | MEDLINE | ID: mdl-22998716

ABSTRACT

BACKGROUND: The millions of peripheral intravenous catheters used each year are recommended for 72-96 h replacement in adults. This routine replacement increases health-care costs and staff workload and requires patients to undergo repeated invasive procedures. The effectiveness of the practice is not well established. Our hypothesis was that clinically indicated catheter replacement is of equal benefit to routine replacement. METHODS: This multicentre, randomised, non-blinded equivalence trial recruited adults (≥18 years) with an intravenous catheter of expected use longer than 4 days from three hospitals in Queensland, Australia, between May 20, 2008, and Sept 9, 2009. Computer-generated random assignment (1:1 ratio, no blocking, stratified by hospital, concealed before allocation) was to clinically indicated replacement, or third daily routine replacement. Patients, clinical staff, and research nurses could not be masked after treatment allocation because of the nature of the intervention. The primary outcome was phlebitis during catheterisation or within 48 h after removal. The equivalence margin was set at 3%. Primary analysis was by intention to treat. Secondary endpoints were catheter-related bloodstream and local infections, all bloodstream infections, catheter tip colonisation, infusion failure, catheter numbers used, therapy duration, mortality, and costs. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12608000445370. FINDINGS: All 3283 patients randomised (5907 catheters) were included in our analysis (1593 clinically indicated; 1690 routine replacement). Mean dwell time for catheters in situ on day 3 was 99 h (SD 54) when replaced as clinically indicated and 70 h (13) when routinely replaced. Phlebitis occurred in 114 of 1593 (7%) patients in the clinically indicated group and in 114 of 1690 (7%) patients in the routine replacement group, an absolute risk difference of 0·41% (95% CI -1·33 to 2·15%), which was within the prespecified 3% equivalence margin. No serious adverse events related to study interventions occurred. INTERPRETATION: Peripheral intravenous catheters can be removed as clinically indicated; this policy will avoid millions of catheter insertions, associated discomfort, and substantial costs in both equipment and staff workload. Ongoing close monitoring should continue with timely treatment cessation and prompt removal for complications. FUNDING: Australian National Health and Medical Research Council.


Subject(s)
Catheter-Related Infections/etiology , Catheterization, Peripheral/instrumentation , Adolescent , Adult , Aged , Catheter-Related Infections/economics , Catheter-Related Infections/epidemiology , Catheter-Related Infections/prevention & control , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/economics , Catheterization, Peripheral/methods , Device Removal/economics , Equipment Contamination/economics , Female , Health Care Costs/statistics & numerical data , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Phlebitis/economics , Phlebitis/epidemiology , Phlebitis/etiology , Phlebitis/prevention & control , Queensland/epidemiology , Time Factors , Treatment Outcome , Young Adult
13.
Infect Control Hosp Epidemiol ; 33(3): 250-6, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22314062

ABSTRACT

OBJECTIVE: To evaluate the economic impact of ventilator-associated pneumonia (VAP) on length of stay and hospital costs. Design. Retrospective matched cohort study. SETTING: Premier database of hospitals in the United States. PATIENTS: Eligible patients were admitted to intensive care units (ICUs), received mechanical ventilation for ≥2 calendar-days, and were discharged between October 1, 2008, and December 31, 2009. METHODS: VAP was defined by International Classification of Diseases, Ninth Revision (ICD-9), code 997.31 and ventilation charges for ≥2 calendar-days. We matched patients with VAP to patients without VAP by propensity score on the basis of demographics, administrative data, and severity of illness. Cost was based on provider perspective and procedural cost accounting methods. RESULTS: Of 88,689 eligible patients, 2,238 (2.5%) had VAP; the incidence rate was 1.27 per 1,000 ventilation-days. In the matched cohort, patients with VAP ([Formula: see text]) had longer mean durations of mechanical ventilation (21.8 vs 10.3 days), ICU stay (20.5 vs 11.6 days), and hospitalization (32.6 vs 19.5 days; all [Formula: see text]) than patients without VAP ([Formula: see text]). Mean hospitalization costs were $99,598 for patients with VAP and $59,770 for patients without VAP ([Formula: see text]), resulting in an absolute difference of $39,828. Patients with VAP had a lower in-hospital mortality rate than patients without VAP (482/2,144 [22.5%] vs 630/2,144 [29.4%]; [Formula: see text]). CONCLUSIONS: Our findings suggest that VAP continues to occur as defined by the new specific ICD-9 code and is associated with a statistically significant resource utilization burden, which underscores the need for cost-effective interventions to minimize the occurrence of this complication.


Subject(s)
Cross Infection/economics , Cross Infection/epidemiology , Equipment Contamination/economics , Health Care Costs/statistics & numerical data , Pneumonia, Ventilator-Associated/economics , Pneumonia, Ventilator-Associated/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Analysis of Variance , Cohort Studies , Cross Infection/etiology , Databases, Factual , Female , Hospitals , Humans , Intensive Care Units , Length of Stay , Male , Middle Aged , Risk Factors , United States/epidemiology , Young Adult
14.
Infect Control Hosp Epidemiol ; 32(2): 101-14, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21460463

ABSTRACT

OBJECTIVE: To estimate the proportion of healthcare-associated infections (HAIs) in US hospitals that are "reasonably preventable," along with their related mortality and costs. METHODS: To estimate preventability of catheter-associated bloodstream infections (CABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), and ventilator-associated pneumonia (VAP), we used a federally sponsored systematic review of interventions to reduce HAIs. Ranges of preventability included the lowest and highest risk reductions reported by US studies of "moderate" to "good" quality published in the last 10 years. We used the most recently published national data to determine the annual incidence of HAIs and associated mortality. To estimate incremental cost of HAIs, we performed a systematic review, which included costs from studies in general US patient populations. To calculate ranges for the annual number of preventable infections and deaths and annual costs, we multiplied our infection, mortality, and cost figures with our ranges of preventability for each HAI. RESULTS: As many as 65%-70% of cases of CABSI and CAUTI and 55% of cases of VAP and SSI may be preventable with current evidence-based strategies. CAUTI may be the most preventable HAI. CABSI has the highest number of preventable deaths, followed by VAP. CABSI also has the highest cost impact; costs due to preventable cases of VAP, CAUTI, and SSI are likely less. CONCLUSIONS: Our findings suggest that 100% prevention of HAIs may not be attainable with current evidence-based prevention strategies; however, comprehensive implementation of such strategies could prevent hundreds of thousands of HAIs and save tens of thousands of lives and billions of dollars.


Subject(s)
Catheter-Related Infections , Catheters/adverse effects , Cross Infection , Equipment Contamination , Catheter-Related Infections/economics , Catheter-Related Infections/epidemiology , Catheter-Related Infections/prevention & control , Catheters/microbiology , Costs and Cost Analysis , Cross Infection/economics , Cross Infection/epidemiology , Cross Infection/mortality , Cross Infection/prevention & control , Equipment Contamination/economics , Equipment Contamination/prevention & control , Health Care Surveys , Humans , Infection Control/methods , Pneumonia, Ventilator-Associated/economics , Pneumonia, Ventilator-Associated/epidemiology , Pneumonia, Ventilator-Associated/prevention & control , Regression Analysis , Risk Assessment , Sepsis/economics , Sepsis/etiology , Sepsis/prevention & control , Surgical Wound Infection/economics , Surgical Wound Infection/epidemiology , Surgical Wound Infection/etiology , Surgical Wound Infection/prevention & control , United States/epidemiology , Urinary Tract Infections/economics , Urinary Tract Infections/epidemiology , Urinary Tract Infections/etiology , Urinary Tract Infections/prevention & control
15.
J Hosp Infect ; 77(3): 233-6, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21216032

ABSTRACT

Blood cultures have an important role in the diagnosis of serious infections, although contamination of blood cultures (i.e. false-positive blood cultures) is a common problem within the hospital setting. The objective of the present investigation was to determine the impact of the false-positive blood culture results on the following outcomes: length of stay, hotel costs, antimicrobial costs, and costs of laboratory and radiological investigation. A retrospective case-control study design was used in which 142 false-positive blood culture cases were matched with suitable controls (patients for whom cultures were reported as true negatives). The matching criteria included age, comorbidity score and month of admission to the hospital. The research covered a 13-month period (July 2007 to July 2008). The findings indicated that differences in means, between cases and controls, for the length of hospital stay and the total costs were 5.4 days [95% CI (confidence interval): 2.8-8.1 days; P<0.001] and £5,001.5 [$7,502.2; 95% CI: £3,283.9 ($4,925.8) to £6,719.1 ($10,078.6); P<0.001], respectively. Consequently, and considering that 254 false-positive blood cultures had occurred in the study site hospital over a one-year period, patients with false-positive blood cultures added 1372 extra hospital days and incurred detrimental additional hospital costs of £1,270,381 ($1,905,572) per year. The findings therefore demonstrate that false-positive blood cultures have a significant impact on increasing hospital length of stay, laboratory and pharmacy costs. These findings highlight the need to intervene to raise the standard of blood-culture-taking technique, thus improving both the quality of patient care and resource use.


Subject(s)
Blood/microbiology , Cross Infection/economics , Culture Media/economics , Equipment Contamination/economics , Hospital Costs , Adult , Aged , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Bacteriological Techniques/economics , Blood Specimen Collection/methods , Case-Control Studies , Cost-Benefit Analysis , Cross Infection/drug therapy , False Positive Reactions , Female , Hospitals , Humans , Length of Stay/economics , Male , Middle Aged , Young Adult
16.
Br Dent J ; 209(2): 87-8, 2010 Jul 24.
Article in English | MEDLINE | ID: mdl-20651774

ABSTRACT

Since August 2009, members of the Primary Care Dentistry Research Forum (http://www.dentistryresearch.org) have taken part in an online vote to identify questions in day-to-day practice that they felt most needed to be answered with conclusive research. The question which receives the most votes each month forms the subject of a critical appraisal of the relevant literature. Each month a new round of voting takes place to decide which further questions will be reviewed. Dental practitioners and dental care professionals are encouraged to take part in the voting and submit their own questions to be included in the vote by joining the website.The paper below details a summary of the findings of the seventh critical appraisal. In conclusion, the critical appraisal identified no evidence on the epidemiological scale of cross-infection caused in dental practices and therefore also of the cost impact of cross-infection caused in primary dental practices. As a result, no 'cost of illness', or cost-benefit assessment, exists or is feasible at this time.


Subject(s)
Cost of Illness , Cross Infection/prevention & control , Dental Care/adverse effects , Evidence-Based Dentistry , Infection Control, Dental/economics , Infections/epidemiology , Cost-Benefit Analysis , Disinfection/economics , Disinfection/methods , Economics, Dental , Equipment Contamination/economics , Humans , Infection Control, Dental/methods , Infections/etiology , United Kingdom
17.
World Neurosurg ; 74(4-5): 528-31, 2010.
Article in English | MEDLINE | ID: mdl-21492607

ABSTRACT

OBJECTIVE: To determine if use of antibiotic-impregnated shunt (AIS) systems to reduce cerebrospinal fluid (CSF) shunt infections in adult patients with hydrocephalus has been cost-effective at one institution. METHODS: All adult patients undergoing CSF shunt insertion over a 7-year period at the Johns Hopkins Hospital were retrospectively reviewed (2004-2009). In 2006, a categorical switch to AIS catheters was made. Before 2006, standard nonimpregnated shunt catheters were used. The 1-year incidence of shunt infection was retrospectively assessed and accounting and billing records were reviewed to determine shunt infection-related medical costs for patients undergoing AIS vs non-AIS shunt surgery. RESULTS: A total of 500 (250 AIS, 250 non-AIS) shunt surgeries were performed for normal-pressure hydrocephalus (NPH) (n = 378 [76%]), pseudotumor cerebri (n = 83 [17%]), and various obstructive and communicating hydrocephalus etiologies (n = 40 [8%]). The incidence of shunt infection was decreased in the AIS (1.2%) vs non-AIS (4.0%) cohorts (P = .0492. Overall, the mean cost per shunt infection was $40,371. Per 250 shunts placed, the total infection-related cost was reduced from $321,407 to $203,424 after the conversion to AIS catheters. AIS catheters were associated with direct cost savings of $47,193 per 100 shunt surgeries performed. CONCLUSIONS: In a retrospective cohort study of 500 CSF shunt surgeries performed in adult patients with hydrocephalus, this institution's categorical conversion to AIS catheters was associated with a significant reduction in infection-related medical costs within the first year after surgery. Although prospective randomized cost-utility studies are needed to confirm these observations, these results suggest that AIS catheters are cost-effective in the treatment of hydrocephalus in adult patients.


Subject(s)
Anti-Bacterial Agents/economics , Catheters, Indwelling/economics , Cerebrospinal Fluid Shunts/economics , Equipment Contamination/economics , Hydrocephalus/surgery , Surgical Wound Infection/drug therapy , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Baltimore , Catheters, Indwelling/adverse effects , Cerebrospinal Fluid Shunts/adverse effects , Cohort Studies , Cost-Benefit Analysis , Equipment Contamination/prevention & control , Female , Hospitals, Teaching , Humans , Hydrocephalus/physiopathology , Male , Middle Aged , Retrospective Studies , Surgical Wound Infection/epidemiology , Surgical Wound Infection/prevention & control , Young Adult
18.
Infect Control Hosp Epidemiol ; 30(8): 759-63, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19538095

ABSTRACT

OBJECTIVE: To conduct a cost-effectiveness analysis of the economic outcomes of ventilator-associated pneumonia (VAP) prevention associated with silver-coated endotracheal tubes versus uncoated endotracheal tubes. DESIGN: We used a simple decision model based on a hypothetical 1,000-patient cohort intubated with silver-coated or uncoated endotracheal tubes. The primary end point was marginal hospital savings per case of VAP prevented (savings from using silver-coated endotracheal tubes minus acquisition cost divided by number of VAP cases prevented). METHODS: We followed each branch of the decision model to VAP or no VAP and conducted Monte Carlo simulations and sensitivity analyses. Inputs for VAP incidence, relative risk reduction, and hospital costs were derived from publicly available sources. Relative risk reduction was derived from the pivotal study of the silver-coated endotracheal tube. RESULTS: In the base-case analysis, we reduced the pivotal study relative risk in incidence of microbiologically confirmed VAP in patients intubated 24 hours from 35.9% to 24%. Thus, 23 of 97 expected cases of VAP could be prevented with silver-coated endotracheal tubes. The savings per case of VAP prevented was $12,840 in the base case, with assumed marginal VAP cost of $16,620 and costs of $90.00 for coated and $2.00 for uncoated endotracheal tubes. Estimates were most sensitive to assumptions regarding VAP cost and relative risk reduction with silver-coated endotracheal tubes. Nonetheless, in multivariate sensitivity analyses, the silver-coated endotracheal tubes yielded persistent savings (95% confidence interval, $9,630-$16,356) per case of VAP prevented. With other base-case inputs held constant, break-even cost for silver-coated endotracheal tubes was $388. CONCLUSIONS: The silver-coated endotracheal tube represents a strategy for preventing VAP that may yield hospital savings.


Subject(s)
Hospital Costs , Intubation, Intratracheal/instrumentation , Pneumonia, Ventilator-Associated/economics , Pneumonia, Ventilator-Associated/prevention & control , Silver Compounds , Cost-Benefit Analysis , Equipment Contamination/economics , Equipment Contamination/prevention & control , Humans , Incidence , Infection Control , Intubation, Intratracheal/adverse effects , Intubation, Intratracheal/economics , Monte Carlo Method , Pneumonia, Ventilator-Associated/epidemiology , Pneumonia, Ventilator-Associated/microbiology , Respiration, Artificial/instrumentation , Risk Assessment , Silver Compounds/economics
19.
J Clin Microbiol ; 47(4): 1021-4, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19171686

ABSTRACT

We conducted a prospective comparison of blood culture contamination rates associated with dedicated phlebotomists and nonphlebotomy staff in the emergency department (ED) at Parkland Memorial Hospital in Dallas, TX. In addition, hospital charges and lengths of stay were determined for patients with negative, false-positive, and true-positive blood culture results. A total of 5,432 blood culture collections from two ED areas, the western wing of the ED (ED west) and the nonwestern wing of the ED (ED nonwest), were evaluated over a 13-month period. Phlebotomists drew 2,012 (55%) of the blood cultures in ED west while nonphlebotomy staff drew 1,650 (45%) in ED west and 1,770 (100%) in ED nonwest. The contamination rates of blood cultures collected by phlebotomists were significantly lower than those collected by nonphlebotomists in ED west (62/2,012 [3.1%] versus 122/1,650 [7.4%]; P < 0.001). Similar results were observed when rates between phlebotomists in ED west and nonphlebotomy staff in ED nonwest were compared (62/2,012 [3.1%] versus 100/1,770 [5.6%]; P < 0.001). Comparison of median patient charges between negative and false-positive episodes ($18,752 versus $27,472) showed $8,720 in additional charges per contamination event while the median length of stay increased marginally from 4 to 5 days. By utilizing phlebotomists to collect blood cultures in the ED, contamination rates were lowered to recommended levels, with projected reductions in patient charges of approximately $4.1 million per year.


Subject(s)
Bacteria/isolation & purification , Bacterial Infections/diagnosis , Blood Specimen Collection/methods , Blood/microbiology , Diagnostic Errors/economics , Equipment Contamination/economics , Phlebotomy/adverse effects , Adult , Aged , Emergency Service, Hospital , Female , Health Care Costs , Health Expenditures , Hospitals , Humans , Length of Stay , Male , Middle Aged , Phlebotomy/economics , Prospective Studies
20.
Healthc Financ Manage ; 62(11): 110-2, 114, 116, 2008 Nov.
Article in English | MEDLINE | ID: mdl-18990844

ABSTRACT

FASB statements and SEC guidelines give direction as to how healthcare organizations should account for their asset retirement obligations (AROs) where environmental issues are concerned. A key consideration is that current costs associated with environmental problems, such as encapsulating asbestos, are to be accounted for as part of an asset's cost and depreciated over the asset's remaining life.


Subject(s)
Accounting/standards , Environmental Restoration and Remediation/economics , Equipment Contamination/economics , Government Regulation , Guidelines as Topic , Health Facility Closure/economics , Accounting/legislation & jurisprudence , Commerce/legislation & jurisprudence , Cost Allocation , Documentation , Financial Audit , Health Facility Closure/legislation & jurisprudence , Humans , Liability, Legal , Risk Adjustment/economics , United States
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