- Email: [email protected]
P5.04 Rate of Acquisition of Bacteraemia in a General Intensive Care Unit
Poster Presentations
S31
P5.03 Infections Following Orthopaedic Surgery – Robbing Peter To Pay Paul? C. Boardman *, M. Richards, P. Russo, A. Bull. VICNISS Coordinating Centre, Australia Background: Hospital-acquired infections have been estimated to cost the Australian healthcare system as much as $AUS 40 million per year; however, there is a lack of current, reliable local data to support this finding. Aim: In an attempt to capture direct and indirect costs attributed to surgical site infections of hip and knee prostheses in Victorian hospitals, the VICNISS Coordinating Centre carried out an economic costing study that examined: estimated average cost per infection; attributable mortality of surgical site infections; a comparison of average attributable costs per facility and by type of infection surgical site infection (superficial, deep and organ space); additional burden of cost to healthcare facilities for acquisition of a multi-resistant organism (MRO). Methods: Using an Appropriateness Evaluation Protocol (AEP), 126 records from 14 hospitals between November 2002 and June 2004 were examined to calculate excess length of stay (LOS), cost/hospital bed day, treatment, diagnostic and procedure costs (radiology and pathology), morbidity (total loss of implant) and mortality rate (most likely cause of death due to implant infection). Results: 126 infections cost Victoria $5,019,994 (potentially $7.65 million) with mortality rate of 5% and, morbidity of 19% and, an average excess LOS/infection/patient of 27 days. (Total = 3407 excess bed days). There is considerable variation in costs relating to infection type, LOS and facility. Conclusions: Almost all the total cost is derived from the excess patient LOS ($4,587,127) than when additional hospital costs for SSI treatment alone were added together ($432,868). The most significant expenses arise from extra LOS, re-operation and antibiotic usage costs and where a deep SSI’s was acquired. Data demonstrates how economic arguments for Infection Control programs can facilitate renewed and ongoing success of IC programs. The VICNISS study may be extrapolated to countries with comparable healthcare systems. P5.04 Rate of Acquisition of Bacteraemia in a General Intensive Care Unit D. Thompson *. Medway Maritime Hospital, UK Background: Bacteraemia is common in the intensive care unit, and its frequency may be related to length of stay, severity of illness and invasive procedures. Aims: To estimate the rate of acquisition of bacteraemia in ICU patients. Methods: During 1996–2005 admissions were logged on a database and day one APACHE II score (APII) calculated. Blood culture (BC) results were stored separately. 14 pathogens were studied. Rate of acquisition of bacteraemia during any period was estimated as the number of BC growing any of 14 pathogens divided by the number of patient bed days. Results: 4270 of 4808 admissions qualified for APII scoring and had complete data. 2435 samples were cultured. 293 patients had 356 separate bacteraemias. 5.6% of all admissions, 13.3% of those in ICU >4 days, and 42% > 35 days had at least one+BC. The incidence of bacteraemia and the proportion of BCs positive were least on the 3rd day after admission. Day in ICU
1
2
3
4
5
+BC/1000 +BC/BC (%)
11.9* 20.7*
8.8* 13.5
2.7 8.6
6.5* 21.7*
7.0* 26.8*
*p < 0.05 compared to day 3.
Days in ICU
+BC
Bed days
/1000 bed days
95% CI
5–19 20–34 5–34
199 41 240
10362 2351 12713
19.2 17.4 18.9
16.6–21.8 12.1–22.7 16.5–21.3
The rate of acquisition varied little between days 5–34 after admission, and this rate was similar in 1996–2000, 17.3 (11.4– 22.1), and 2001–05, 20.8 (17.1–24.6). Division by quartiles (Q) of APII showed no difference between Q1 and 2, or Q3 and Q4. The rate was higher in Q3+4 (APII >17), 21.6 (18.2–25) than Q1+2, 15.7 (12.5–18.9): RR 1.38 (1.08–1.79). The rate was no greater in those undergoing haemofiltration. Conclusions: The sharp decline in rate of bacteraemia and proportion of BC that grew pathogens on day 3 suggests that thereafter bacteraemia was largely ICU-acquired. Length of stay predicted the risk of bacteraemia. The increasing proprtion of patients with bacteraemia with lengthing stay was due to longer exposure to a constant risk. That risk was greater in the sicker patients; there was a threshold rather than a contiuous effect of increasing APII. This pattern of acquisition has changed little over ten years. P5.05 Financial Costs Associated with the Initial Treatment of a Healthcare Worker who has Seroconverted to Hepatitis B, C or HIV Following a Needlestick Injury D. Adams *, T. Elliott. University Hospital Birmingham NHS Foundation Trust, UK Background: Needlestick injuries (NSI) can pose a serious risk to healthcare workers (HCW) from blood borne viruses. In addition, they can create a financial burden to healthcare facilities from the initial treatment associated with these injuries. Aim: To determine the financial costs associated with the initial six to 12 months treatment of a HCW, if they seroconvert to a blood borne virus following a contaminated NSI. Methods: The financial costs attributable to the initial six to 12 month therapy of a nurse who sustained a NSI and subsequently seroconverted to hepatitis B, C or HIV at a university teaching hospital in the United Kingdom (UK) were determined. These included; post exposure prophylaxis, serological investigations, healthcare consultations/assessments and time associated with attending clinic appointments. Results: The approximate financial costs associated with seroconversion to hepatitis B, C and HIV following a NSI were: Hepatitis B £607, Hepatitis C £7298 and HIV £938. Conclusion: The analysis does not take into account any personal or psychological costs experienced by the individual or their family, nor the potential effects on future career options should the treatments be unsuccessful. It is essential that healthcare providers are aware of both the financial and psychological costs associated with NSI in order to determine effective strategies to reduce HCW exposure. P5.06 Financial Costs Associated with a Contaminated Needlestick Injury D. Adams *, T. Elliott. University Hospital Birmingham NHS Foundation Trust, UK Background: Needlestick injuries (NSI), pose a serious risk to healthcare workers (HCW) from contamination. It is essential that healthcare facilities are aware of the costs associated with NSI in order to determine future preventative strategies. Aim: To determine the financial costs associated with the initial treatment of a nurse following a contaminated NSI from a hepatitis B, C and HIV source patient.
S31
P5.03 Infections Following Orthopaedic Surgery – Robbing Peter To Pay Paul? C. Boardman *, M. Richards, P. Russo, A. Bull. VICNISS Coordinating Centre, Australia Background: Hospital-acquired infections have been estimated to cost the Australian healthcare system as much as $AUS 40 million per year; however, there is a lack of current, reliable local data to support this finding. Aim: In an attempt to capture direct and indirect costs attributed to surgical site infections of hip and knee prostheses in Victorian hospitals, the VICNISS Coordinating Centre carried out an economic costing study that examined: estimated average cost per infection; attributable mortality of surgical site infections; a comparison of average attributable costs per facility and by type of infection surgical site infection (superficial, deep and organ space); additional burden of cost to healthcare facilities for acquisition of a multi-resistant organism (MRO). Methods: Using an Appropriateness Evaluation Protocol (AEP), 126 records from 14 hospitals between November 2002 and June 2004 were examined to calculate excess length of stay (LOS), cost/hospital bed day, treatment, diagnostic and procedure costs (radiology and pathology), morbidity (total loss of implant) and mortality rate (most likely cause of death due to implant infection). Results: 126 infections cost Victoria $5,019,994 (potentially $7.65 million) with mortality rate of 5% and, morbidity of 19% and, an average excess LOS/infection/patient of 27 days. (Total = 3407 excess bed days). There is considerable variation in costs relating to infection type, LOS and facility. Conclusions: Almost all the total cost is derived from the excess patient LOS ($4,587,127) than when additional hospital costs for SSI treatment alone were added together ($432,868). The most significant expenses arise from extra LOS, re-operation and antibiotic usage costs and where a deep SSI’s was acquired. Data demonstrates how economic arguments for Infection Control programs can facilitate renewed and ongoing success of IC programs. The VICNISS study may be extrapolated to countries with comparable healthcare systems. P5.04 Rate of Acquisition of Bacteraemia in a General Intensive Care Unit D. Thompson *. Medway Maritime Hospital, UK Background: Bacteraemia is common in the intensive care unit, and its frequency may be related to length of stay, severity of illness and invasive procedures. Aims: To estimate the rate of acquisition of bacteraemia in ICU patients. Methods: During 1996–2005 admissions were logged on a database and day one APACHE II score (APII) calculated. Blood culture (BC) results were stored separately. 14 pathogens were studied. Rate of acquisition of bacteraemia during any period was estimated as the number of BC growing any of 14 pathogens divided by the number of patient bed days. Results: 4270 of 4808 admissions qualified for APII scoring and had complete data. 2435 samples were cultured. 293 patients had 356 separate bacteraemias. 5.6% of all admissions, 13.3% of those in ICU >4 days, and 42% > 35 days had at least one+BC. The incidence of bacteraemia and the proportion of BCs positive were least on the 3rd day after admission. Day in ICU
1
2
3
4
5
+BC/1000 +BC/BC (%)
11.9* 20.7*
8.8* 13.5
2.7 8.6
6.5* 21.7*
7.0* 26.8*
*p < 0.05 compared to day 3.
Days in ICU
+BC
Bed days
/1000 bed days
95% CI
5–19 20–34 5–34
199 41 240
10362 2351 12713
19.2 17.4 18.9
16.6–21.8 12.1–22.7 16.5–21.3
The rate of acquisition varied little between days 5–34 after admission, and this rate was similar in 1996–2000, 17.3 (11.4– 22.1), and 2001–05, 20.8 (17.1–24.6). Division by quartiles (Q) of APII showed no difference between Q1 and 2, or Q3 and Q4. The rate was higher in Q3+4 (APII >17), 21.6 (18.2–25) than Q1+2, 15.7 (12.5–18.9): RR 1.38 (1.08–1.79). The rate was no greater in those undergoing haemofiltration. Conclusions: The sharp decline in rate of bacteraemia and proportion of BC that grew pathogens on day 3 suggests that thereafter bacteraemia was largely ICU-acquired. Length of stay predicted the risk of bacteraemia. The increasing proprtion of patients with bacteraemia with lengthing stay was due to longer exposure to a constant risk. That risk was greater in the sicker patients; there was a threshold rather than a contiuous effect of increasing APII. This pattern of acquisition has changed little over ten years. P5.05 Financial Costs Associated with the Initial Treatment of a Healthcare Worker who has Seroconverted to Hepatitis B, C or HIV Following a Needlestick Injury D. Adams *, T. Elliott. University Hospital Birmingham NHS Foundation Trust, UK Background: Needlestick injuries (NSI) can pose a serious risk to healthcare workers (HCW) from blood borne viruses. In addition, they can create a financial burden to healthcare facilities from the initial treatment associated with these injuries. Aim: To determine the financial costs associated with the initial six to 12 months treatment of a HCW, if they seroconvert to a blood borne virus following a contaminated NSI. Methods: The financial costs attributable to the initial six to 12 month therapy of a nurse who sustained a NSI and subsequently seroconverted to hepatitis B, C or HIV at a university teaching hospital in the United Kingdom (UK) were determined. These included; post exposure prophylaxis, serological investigations, healthcare consultations/assessments and time associated with attending clinic appointments. Results: The approximate financial costs associated with seroconversion to hepatitis B, C and HIV following a NSI were: Hepatitis B £607, Hepatitis C £7298 and HIV £938. Conclusion: The analysis does not take into account any personal or psychological costs experienced by the individual or their family, nor the potential effects on future career options should the treatments be unsuccessful. It is essential that healthcare providers are aware of both the financial and psychological costs associated with NSI in order to determine effective strategies to reduce HCW exposure. P5.06 Financial Costs Associated with a Contaminated Needlestick Injury D. Adams *, T. Elliott. University Hospital Birmingham NHS Foundation Trust, UK Background: Needlestick injuries (NSI), pose a serious risk to healthcare workers (HCW) from contamination. It is essential that healthcare facilities are aware of the costs associated with NSI in order to determine future preventative strategies. Aim: To determine the financial costs associated with the initial treatment of a nurse following a contaminated NSI from a hepatitis B, C and HIV source patient.