Raising Standards While Watching the Bottom Line: Making a Business Case for Infection Control •

Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 11/2007; 28(10):1121-33. DOI: 10.1086/521852
Source: PubMed


While society would benefit from a reduced incidence of nosocomial infections, there is currently no direct reimbursement to hospitals for the purpose of infection control, which forces healthcare institutions to make economic decisions about funding infection control activities. Demonstrating value to administrators is an increasingly important function of the hospital epidemiologist because healthcare executives are faced with many demands and shrinking budgets. Aware of the difficulties that face local infection control programs, the Society for Healthcare Epidemiology of America (SHEA) Board of Directors appointed a task force to draft this evidence-based guideline to assist hospital epidemiologists in justifying and expanding their programs. In Part 1, we describe the basic steps needed to complete a business-case analysis for an individual institution. A case study based on a representative infection control intervention is provided. In Part 2, we review important basic economic concepts and describe approaches that can be used to assess the financial impact of infection prevention, surveillance, and control interventions, as well as the attributable costs of specific healthcare-associated infections. Both parts of the guideline aim to provide the hospital epidemiologist, infection control professional, administrator, and researcher with the tools necessary to complete a thorough business-case analysis and to undertake an outcome study of a nosocomial infection or an infection control intervention.

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Article: Raising Standards While Watching the Bottom Line: Making a Business Case for Infection Control •

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    • "Despite these limitations, we believe that our tool can help infection control professionals demonstrate the values of CAUTI prevention efforts to key administrators, particularly at a time where it has become increasingly necessary to develop a business case to initiate new interventions or justify the continued support for ongoing programs.12 Additionally, we believe the proposed approach can be an important supplement to initiatives like the Society of Hospital Medicine's Choosing Wisely campaign, which aims to help reduce inappropriate urinary catheter use. "
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    ABSTRACT: Healthcare-associated infections are common, costly, and potentially deadly. However, effective prevention strategies are underutilized, particularly for catheter-associated urinary tract infection (CAUTI), one of the most common healthcare-associated infections. Further, since 2008, the Centers for Medicare and Medicaid Services no longer reimburses hospitals for the additional costs of caring for patients who develop CAUTI during hospitalization. Given the resulting payment pressures on hospitals stemming from this decision, it is important to factor in cost implications when attempting to encourage decision makers to support infection prevention measures. To this end, we present a simple tool (with easy-to-use online implementation) that hospitals can use to estimate hospital costs due to CAUTI, both before and after an intervention, to reduce inappropriate urinary catheterization. Using previously published cost and risk estimates, we show that an intervention yielding clinically feasible reductions in catheter use can lead to an estimated 50% reduction in CAUTI-related costs. Our tool is meant to complement the Society of Hospital Medicine's Choosing Wisely campaign, which highlights avoiding placement or continued use of nonindicated urinary catheters as a key area for improving decision making and quality of care while decreasing costs. Journal of Hospital Medicine 2013;8:519-522. © 2013 Society of Hospital Medicine.
    Journal of Hospital Medicine 09/2013; 8(9):519-22. DOI:10.1002/jhm.2079 · 2.30 Impact Factor
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    • "To assess the potential value of infection prevention initiatives in hospital and community settings within a business-case analysis framework, a better understanding of the long-term clinical and economic consequences of these infections is necessary [14]. Hence, the aim of this study was to examine in Medicare patients admitted to an ICU and discharged alive: the relationships between sepsis, pneumonia, central-line-associated bloodstream infections (CLABSI), and ventilator-associated pneumonia (VAP); the relationships between the infections and long-term survival and resource utilization; and to determine how much of the resource utilization was related to impending death during the follow up period. "
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    ABSTRACT: Background Hospital associated infections are major problems, which are increasing in incidence and very costly. However, most research has focused only on measuring consequences associated with the initial hospitalization. We explored the long-term consequences of infections in elderly Medicare patients admitted to an intensive care unit (ICU) and discharged alive, focusing on: sepsis, pneumonia, central-line-associated bloodstream infections (CLABSI), and ventilator-associated pneumonia (VAP); the relationships between the infections and long-term survival and resource utilization; and how resource utilization was related to impending death during the follow up period. Methods Clinical data and one year pre- and five years post-index hospitalization Medicare records were examined. Hazard ratios (HR) and healthcare utilization incidence ratios (IR) were estimated from state of the art econometric models. Patient demographics (i.e., age, gender, race and health status) and Medicaid status (i.e., dual eligibility) were controlled for in these models. Results In 17,537 patients, there were 1,062 sepsis, 1,802 pneumonia, 42 CLABSI and 52 VAP cases. These subjects accounted for 62,554 person-years post discharge. The sepsis and CLABSI cohorts were similar as were the pneumonia and VAP cohorts. Infection was associated with increased mortality (sepsis HR = 1.39, P < 0.01; and pneumonia HR = 1.58, P < 0.01) and the risk persisted throughout the follow-up period. Persons with sepsis and pneumonia experienced higher utilization than controls (e.g., IR for long-term care utilization for those with sepsis ranged from 2.67 to 1.93 in years 1 through 5); and, utilization was partially related to impending death. Conclusions The infections had significant and lasting adverse consequences among the elderly. Yet, many of these infections may be preventable. Investments in infection prevention interventions are needed in both community and hospitals settings.
    BMC Health Services Research 11/2012; 12(1):432. DOI:10.1186/1472-6963-12-432 · 1.71 Impact Factor
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    • "The Centers for Disease Control and Prevention (CDC) estimates that each year in the United States there are about 1.7 million HAIs and 99,000 associated deaths.[6] The mean direct costs of HAIs (in 2005 dollars) range from $1,257 per case for catheter-associated urinary tract infections to $22,875 per case for ventilator-associated pneumonia.[7] "
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    ABSTRACT: Hospital-associated infections (HAIs) are associated with a considerable burden of disease and direct costs greater than $17 billion. The pathogens that cause the majority of serious HAIs are Enterococcus faecium, Staphylococcus aureus, Clostridium difficile, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species, referred as ESCKAPE. We aimed to determine the amount of funding the National Institute of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID) allocates to research on antimicrobial resistant pathogens, particularly ESCKAPE pathogens. The NIH Research Portfolio Online Reporting Tools (RePORT) database was used to identify NIAID antimicrobial resistance research grants funded in 2007-2009 using the terms "antibiotic resistance," "antimicrobial resistance," and "hospital-associated infection." Funding for antimicrobial resistance grants has increased from 2007-2009. Antimicrobial resistance funding for bacterial pathogens has seen a smaller increase than non-bacterial pathogens. The total funding for all ESKCAPE pathogens was $ 22,005,943 in 2007, $ 30,810,153 in 2008 and $ 49,801,227 in 2009. S. aureus grants received $ 29,193,264 in FY2009, the highest funding amount of all the ESCKAPE pathogens. Based on 2009 funding data, approximately $1,565 of research money was spent per S. aureus related death and $750 of was spent per C. difficile related death. Although the funding for ESCKAPE pathogens has increased from 2007 to 2009, funding levels for antimicrobial resistant bacteria-related grants is still lower than funding for antimicrobial resistant non-bacterial pathogens. Efforts may be needed to improve research funding for resistant-bacterial pathogens, particularly as their clinical burden increases.
    01/2012; 1(1):5. DOI:10.1186/2047-2994-1-5
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