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Cost analysis for a nosocomial outbreak
Volume
19 Number
2
Abstracts
April 1991
EDUCATION PROGRAM FOR INFECI’ION CONTROL NURSES IN NORWAY. M. Storma&* RN, A. Lystad, MD. National Institotc of Public Health, Oslo, Norway. The main institution to teach infection control in Nonvay is the National Institute of Public Health (NIPH). For about two decades most of the national infection contml activities have been initiated by NIPH. The past three years NIPH has also teen responsible for tralning infection control nurses (ICN). The level of understanding of the problems related to nosocomial infection control in Norway has generally been low. In 1976 a plan for the organization of infection control activities also included a proposal for an education program. This plan has never been realized according to the intention. However, in 1988 a government grant was given for education of ICNs. By that time Nonvay had a total number of 24 ICNs, who bad all been gradually prepared for their positions with on-the-job training and short-time courses. Most hospitals had earlier been unwilling to establish positions for ICNs because of the lack of training. Tbe training program then being offemd was also an opportunity for hospitals to appoint positions for trained ICNs. In a shon time 15 new ICN positions were established. Norway is a small country (approximately 20,OCO hospital beds) and the need for ICNs has been estimated to around 80. The training program has been run for three years in order to give all ICNs - old and new - the same skills for doing their job. For the future it is planned to nm the pmgram every third or fifth year to catch up newly appointed ICNs and give them the same background. The curriculum was developed by reviewing the conicula of courses held in other countries. The training program consists of three parts: one theoretical pan. lasting 19 weeks, held at NIPH: one hospital-based pan lasting 25 weeks. AAer a period of practical guidance for two weeks, the numes worked in their own hospitals. During this time they did a small research project. The last part, consisting of two weeks summing up/sharing experience and giving a written exam, was again held at NIPH. By 1990. 40 nurses have been trained. The program will be presented more detailed.
COST ANALYSIS FOR A NOSOCOMIAL OUTBREAK. CA. Genese,* MBA, CIC, KC. Spitalny, MD, S. Paul. MD. New Jersey State Department of Health, Trenton, NJ. In today’s envimnment of spiraling health care costs, all hospital policies, procedures, and programs most be defended in terms of their benelicialness. Infection contml must demonstrate that their activities do not cost the facility more than it is reimbursed for their effolis. A cost-analysis model for nosocomial outbreaks is presented utilizing a true cost accounting approach to determine those direct costs that would not have existed had it not been for the nosocomial infection. The model was applied to a cluster of 4 patients with Gmup A beta hemolytic Strepfococcus surgical wound infections. Our marginal costs are the sum of direct, tangible costs (account receivables. not sunk costs), direct labor costs (wages paid), opportunity costs (lost revenues), and litigation costs (expected cost/patient). Marginal taogible and labor costs were obtained thmugh medical record review by a physician and itemization of costs of receivables. Average LOS was 21.5 days, range 16-28. for what noonally should have been M days. Two patients required ICU care and all bad multiple reoperations. Reimbursements included 2 inlier DRG rates and 2 “poorly defined” clinical DRGs for which the entire hospita3 bill was paid. Marginal reimbursements minus marginal costs resulted in a marginal profit of more than $9,ooO. These results challenge the cost analysis 1itemNR where most authors used the average costs/day as the standard and found that hospital costs for nosocomial infections were not being reimbursed.
PRIMARY NOSOCOMIAL BLOODSTREAM INFECI70N.S IN A TEACHING HOSPITAL. C. McCallum,* MT (ASCP). G. Madden, BSN, C.A. Smith, MD, R. Lyons, MD. St. Francis Hospital & Medcal Center, Hartford, CT. In this 6CO-bed teaching hospital we evaluated all bacteremias from September 1989 thmugh August 1990. The Centers for Disease Control definitions for primary and secondary blwdstream infections (BSI) were followed. All positive blood colfure isolates were categorized as: (1) community acquired; (2) noaocomiak (3) contaminated. There were 23,519 patients admitted, 15549 cultures were drawn and 780 of the blood cultures were positive. Of the positive cultures 289 were community acquired, 301 were contaminated and 190 were oosocomial. The oosocomial BSIs had 79 primary and 111 secondary. 7he oosocomial infected patient rate was 7.2/1wO patient discharges and the primaly oosocomial rate was 3.4/1Mx). Our primary bacteremias were related to central venous catheters in 90% of the episodes. The bacteriology of the 79 primary nosocomial BSIs showed the most frequent causative organisms to be Staphylococcus epidermidis. Staphylococcus aureus, Enterococcus and yeast species. There were 59 (41) Staphylococcus epidennidis I( )=primary]. Staphylococcus aureus 36 (16), Enterococcus 24 (8) and yeast 16 (6). All but 8 of the 79 primary bacteremias were caused by one of these four organisms. We concluded that in our institution gram positive primary bacteremiaa are predominant and most are line related.
COLONIZATION OF ANESTHESIA BREATHING LOWING USE. I. Treston-Aura&,’ RN, MSN. Catherine McAuley Health System, AM Arbor. MI
CIRCUITS FOLC.P. Craig. MD.
Disposable anesthesia breathing circuiu (ABCs) are labeled for one patient use only. However, a telephone survey of anesthesia departments (N= 18) disclosed standard practice is to muse the devices for several patients Our institution, which rarely reuses ABCs, spends approximately $32.000 annually on ABCs with national estimates being approximately $2O,tlOO,ooO. The purpose of this study was to determine the concentration and identity of pathogens located in the elbow/y junction of the ABC after a single use for administration of general anesthesia. Bacterial samples were obtained preoperatively fmm the inspiratory valve sod postopemtively from the elbow/y-junction of the ABC. Length of surgeries ranged from 62 minutes to 460 minutes. Cultures of 21 breathing circuits revealed no growth of micmorgaoisms. Three of 21 (14.0%) inspiratory valve cul~res revealed colony counts with organism identification being 1 colony Diphthemids, 1 colony coagulase negative Staphylococci. sod 8 colonies with a combination of Diphthcmids. Bacillus species and coagulase negative Staphylococci. This study suggests the reused ABC may not lx ao importam source of bacterial infection. Most studies support impaired host defense with aspiration of oral flora as the primary predisposing cause of postoperative pulmonary infection, riot anesthesia apparatus. It is estimated SIO,OfXl could be saved annually at our institution and approximately $7,COO,ooO nation-wide utilizing ABCs on more than one patient.
115
19 Number
2
Abstracts
April 1991
EDUCATION PROGRAM FOR INFECI’ION CONTROL NURSES IN NORWAY. M. Storma&* RN, A. Lystad, MD. National Institotc of Public Health, Oslo, Norway. The main institution to teach infection control in Nonvay is the National Institute of Public Health (NIPH). For about two decades most of the national infection contml activities have been initiated by NIPH. The past three years NIPH has also teen responsible for tralning infection control nurses (ICN). The level of understanding of the problems related to nosocomial infection control in Norway has generally been low. In 1976 a plan for the organization of infection control activities also included a proposal for an education program. This plan has never been realized according to the intention. However, in 1988 a government grant was given for education of ICNs. By that time Nonvay had a total number of 24 ICNs, who bad all been gradually prepared for their positions with on-the-job training and short-time courses. Most hospitals had earlier been unwilling to establish positions for ICNs because of the lack of training. Tbe training program then being offemd was also an opportunity for hospitals to appoint positions for trained ICNs. In a shon time 15 new ICN positions were established. Norway is a small country (approximately 20,OCO hospital beds) and the need for ICNs has been estimated to around 80. The training program has been run for three years in order to give all ICNs - old and new - the same skills for doing their job. For the future it is planned to nm the pmgram every third or fifth year to catch up newly appointed ICNs and give them the same background. The curriculum was developed by reviewing the conicula of courses held in other countries. The training program consists of three parts: one theoretical pan. lasting 19 weeks, held at NIPH: one hospital-based pan lasting 25 weeks. AAer a period of practical guidance for two weeks, the numes worked in their own hospitals. During this time they did a small research project. The last part, consisting of two weeks summing up/sharing experience and giving a written exam, was again held at NIPH. By 1990. 40 nurses have been trained. The program will be presented more detailed.
COST ANALYSIS FOR A NOSOCOMIAL OUTBREAK. CA. Genese,* MBA, CIC, KC. Spitalny, MD, S. Paul. MD. New Jersey State Department of Health, Trenton, NJ. In today’s envimnment of spiraling health care costs, all hospital policies, procedures, and programs most be defended in terms of their benelicialness. Infection contml must demonstrate that their activities do not cost the facility more than it is reimbursed for their effolis. A cost-analysis model for nosocomial outbreaks is presented utilizing a true cost accounting approach to determine those direct costs that would not have existed had it not been for the nosocomial infection. The model was applied to a cluster of 4 patients with Gmup A beta hemolytic Strepfococcus surgical wound infections. Our marginal costs are the sum of direct, tangible costs (account receivables. not sunk costs), direct labor costs (wages paid), opportunity costs (lost revenues), and litigation costs (expected cost/patient). Marginal taogible and labor costs were obtained thmugh medical record review by a physician and itemization of costs of receivables. Average LOS was 21.5 days, range 16-28. for what noonally should have been M days. Two patients required ICU care and all bad multiple reoperations. Reimbursements included 2 inlier DRG rates and 2 “poorly defined” clinical DRGs for which the entire hospita3 bill was paid. Marginal reimbursements minus marginal costs resulted in a marginal profit of more than $9,ooO. These results challenge the cost analysis 1itemNR where most authors used the average costs/day as the standard and found that hospital costs for nosocomial infections were not being reimbursed.
PRIMARY NOSOCOMIAL BLOODSTREAM INFECI70N.S IN A TEACHING HOSPITAL. C. McCallum,* MT (ASCP). G. Madden, BSN, C.A. Smith, MD, R. Lyons, MD. St. Francis Hospital & Medcal Center, Hartford, CT. In this 6CO-bed teaching hospital we evaluated all bacteremias from September 1989 thmugh August 1990. The Centers for Disease Control definitions for primary and secondary blwdstream infections (BSI) were followed. All positive blood colfure isolates were categorized as: (1) community acquired; (2) noaocomiak (3) contaminated. There were 23,519 patients admitted, 15549 cultures were drawn and 780 of the blood cultures were positive. Of the positive cultures 289 were community acquired, 301 were contaminated and 190 were oosocomial. The oosocomial BSIs had 79 primary and 111 secondary. 7he oosocomial infected patient rate was 7.2/1wO patient discharges and the primaly oosocomial rate was 3.4/1Mx). Our primary bacteremias were related to central venous catheters in 90% of the episodes. The bacteriology of the 79 primary nosocomial BSIs showed the most frequent causative organisms to be Staphylococcus epidermidis. Staphylococcus aureus, Enterococcus and yeast species. There were 59 (41) Staphylococcus epidennidis I( )=primary]. Staphylococcus aureus 36 (16), Enterococcus 24 (8) and yeast 16 (6). All but 8 of the 79 primary bacteremias were caused by one of these four organisms. We concluded that in our institution gram positive primary bacteremiaa are predominant and most are line related.
COLONIZATION OF ANESTHESIA BREATHING LOWING USE. I. Treston-Aura&,’ RN, MSN. Catherine McAuley Health System, AM Arbor. MI
CIRCUITS FOLC.P. Craig. MD.
Disposable anesthesia breathing circuiu (ABCs) are labeled for one patient use only. However, a telephone survey of anesthesia departments (N= 18) disclosed standard practice is to muse the devices for several patients Our institution, which rarely reuses ABCs, spends approximately $32.000 annually on ABCs with national estimates being approximately $2O,tlOO,ooO. The purpose of this study was to determine the concentration and identity of pathogens located in the elbow/y junction of the ABC after a single use for administration of general anesthesia. Bacterial samples were obtained preoperatively fmm the inspiratory valve sod postopemtively from the elbow/y-junction of the ABC. Length of surgeries ranged from 62 minutes to 460 minutes. Cultures of 21 breathing circuits revealed no growth of micmorgaoisms. Three of 21 (14.0%) inspiratory valve cul~res revealed colony counts with organism identification being 1 colony Diphthemids, 1 colony coagulase negative Staphylococci. sod 8 colonies with a combination of Diphthcmids. Bacillus species and coagulase negative Staphylococci. This study suggests the reused ABC may not lx ao importam source of bacterial infection. Most studies support impaired host defense with aspiration of oral flora as the primary predisposing cause of postoperative pulmonary infection, riot anesthesia apparatus. It is estimated SIO,OfXl could be saved annually at our institution and approximately $7,COO,ooO nation-wide utilizing ABCs on more than one patient.
115