Asunto(s)
Antibacterianos/uso terapéutico , Enfermedades Transmisibles/tratamiento farmacológico , Farmacorresistencia Microbiana , Antibacterianos/administración & dosificación , Congresos como Asunto , Becas/economía , Humanos , Profesionales para Control de Infecciones/economía , Naciones Unidas , Estados UnidosRESUMEN
BACKGROUND: Antimicrobial stewardship programs have been widely introduced in hospitals as a response to increasing antimicrobial resistance. Although such programs are commonly used, the long-term effects on antimicrobial resistance as well as societal economics are uncertain. METHODS: We performed a cost analysis of an antimicrobial stewardship program introduced in Malmö, Sweden in 20 weeks 2013 compared with a corresponding control period in 2012. All direct costs and opportunity costs related to the stewardship intervention were calculated for both periods. Costs during the stewardship period were directly compared to costs in the control period and extrapolated to a yearly cost. Two main analyses were performed, one including only comparable direct costs (analysis one) and one including comparable direct and opportunity costs (analysis two). An extra analysis including all comparable direct costs including costs related to length of hospital stay (analysis three) was performed, but deemed as unrepresentative. RESULTS: According to analysis one, the cost per year was SEK 161 990 and in analysis two the cost per year was SEK 5 113. Since the two cohorts were skewed in terms of size and of infection severity as a consequence of the program, and since short-term patient outcomes have been demonstrated to be unchanged by the intervention, the costs pertaining to patient outcomes were not included in the analysis, and we suggest that analysis two provides the most correct cost calculation. In this analysis, the main cost drivers were the physician time and nursing time. A sensitivity analysis of analysis two suggested relatively modest variation under changing assumptions. CONCLUSION: The total yearly cost of introducing an infectious disease specialist-guided, audit-based antimicrobial stewardship in a department of internal medicine, including direct costs and opportunity costs, was calculated to be as low as SEK 5 113.
Asunto(s)
Antiinfecciosos/uso terapéutico , Farmacorresistencia Microbiana , Profesionales para Control de Infecciones/estadística & datos numéricos , Infecciones/tratamiento farmacológico , Especialización , Anciano de 80 o más Años , Antiinfecciosos/economía , Costos y Análisis de Costo , Humanos , Profesionales para Control de Infecciones/economía , Infecciones/economía , Tiempo de Internación , Prevalencia , SueciaRESUMEN
BACKGROUND: This article describes infection prevention and control professionals' (ICPs') staffing levels, patient outcomes, and costs associated with the provision of infection prevention and control services in Australian hospitals. A secondary objective was to determine the priorities for infection control units. METHODS: A cross-sectional study design was used. Infection control units in Australian public and private hospitals completed a Web-based anonymous survey. Data collected included details about the respondent; hospital demographics; details and services of the infection control unit; and a description of infection prevention and control-related outputs, patient outcomes, and infection control priorities. RESULTS: Forty-nine surveys were undertaken, accounting for 152 Australian hospitals. The mean number of ICPs was 0.66 per 100 overnight beds (95% confidence interval, 0.55-0.77). Privately funded hospitals have significantly fewer ICPs per 100 overnight beds compared with publicly funded hospitals (P < .01). Staffing costs for nursing staff in infection control units in this study totaled $16,364,392 (mean, $380,566). Infection control units managing smaller hospitals (<270 beds) identified the need for increased access to infectious diseases or microbiology support. CONCLUSION: This study provides valuable information to support future decisions by funders, hospital administrators, and ICPs on service delivery models for infection prevention and control. Further, it is the first to provide estimates of the resourcing and cost of staffing infection control in hospitals at a national level.
Asunto(s)
Departamentos de Hospitales/organización & administración , Profesionales para Control de Infecciones/provisión & distribución , Control de Infecciones/organización & administración , Admisión y Programación de Personal/economía , Australia , Estudios Transversales , Departamentos de Hospitales/economía , Hospitales Privados/economía , Hospitales Públicos/economía , Humanos , Control de Infecciones/economía , Profesionales para Control de Infecciones/economía , Encuestas y CuestionariosRESUMEN
PURPOSE: A pre-post analysis of an antimicrobial stewardship program (ASP) involving the use of data-mining software to prospectively identify cases for ASP intervention was conducted. METHODS: The investigators evaluated clinical outcomes and cost metrics before and after implementation of the ASP, which entailed daily physician review of summary reports on all adult inpatients receiving antimicrobial therapy. The primary outcome measures were annual antimicrobial expenditures and rates of infections due to common nosocomial pathogens; secondary outcome measures included patient survival and length of stay (LOS) in cases involving the indicator diagnoses of pneumonia and abdominal sepsis. RESULTS: Antimicrobial expenditures, which had increased by an average of 14.4% annually in the years preceding ASP implementation, decreased by 9.75% in the first year of the program and remained relatively stable in subsequent years, with overall cumulative cost savings estimated at $1.7 million. Rates of nosocomial infections involving Clostridium difficile, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci all decreased after ASP implementation. A pre-post comparison of survival and LOS in patients with pneumonia (n = 2186) or abdominal sepsis (n = 225) showed no significant differences in those outcomes in either patient group, possibly due to the hospital's initiation of other, concurrent infection-control programs during the study period. CONCLUSION: A prospective collaborative ASP employed automated reports to efficiently identify key data for ASP review. After ASP implementation, antimicrobial expenditures and rates of nosocomial infections caused by resistant pathogens dropped without significant changes in patient survival, LOS, and readmissions for the two studied illness categories.
Asunto(s)
Antiinfecciosos/economía , Infección Hospitalaria/economía , Costos de la Atención en Salud/tendencias , Profesionales para Control de Infecciones/economía , Evaluación de Resultado en la Atención de Salud/economía , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Anciano , Antiinfecciosos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Costos de los Medicamentos/tendencias , Humanos , Persona de Mediana EdadRESUMEN
The objective of this study was to determine the costs and benefits of the MRSA Search and Destroy policy in a Dutch hospital during 2001 through 2006. Variable costs included costs for isolation, contact tracing, treatment of carriers and closure of wards. Fixed costs were the costs for the building of isolation rooms and the salary of one full-time infection control practitioner. To determine the benefits of the Search and Destroy policy, the transmission rate during the study period was calculated. Furthermore, the number of cases of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia prevented was estimated, as well as its associated prevented costs and patient lives. The costs of the MRSA policy were estimated to be euro 215,559 a year, which equals euro 5.54 per admission. The daily isolation costs for MRSA-suspected and -positive hospitalised patients were euro 95.59 and euro 436.62, respectively. Application of the Search and Destroy policy resulted in a transmission rate of 0.30 and was estimated to prevent 36 cases of MRSA bacteraemia per year, resulting in annual savings of euro 427,356 for the hospital and ten lives per year (95% confidence interval [CI] 8-14). In conclusion, application of the MRSA Search and Destroy policy in a hospital in a country with a low endemic MRSA incidence saves money and lives.
Asunto(s)
Infección Hospitalaria/economía , Infección Hospitalaria/prevención & control , Costos de Hospital , Control de Infecciones/economía , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/economía , Infecciones Estafilocócicas/prevención & control , Antibacterianos/economía , Antibacterianos/uso terapéutico , Bacteriemia/economía , Bacteriemia/prevención & control , Portador Sano/economía , Trazado de Contacto/economía , Análisis Costo-Beneficio , Brotes de Enfermedades/prevención & control , Clausura de las Instituciones de Salud/economía , Política de Salud/economía , Humanos , Control de Infecciones/métodos , Profesionales para Control de Infecciones/economía , Países Bajos , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/transmisiónRESUMEN
La tuberculosis fue una enfermedad estigmatizante, con una fuerte carga valorativa elaborada desde la misma medicina. Este trabajo pretende realizar un análisis de las concepciones médicas acerca de la enfermedad y su repercusión en los enfermos en un ámbito especial como fueron los sanatorios para tuberculosos. Se parte, para el análisis, de una enumeración de los sanatorios en la provincia de Córdoba, para luego estudiar las miradas médicas acerca de los sanatorios y el contagio como el elemento fundamental para la internación de los tuberculosos. Luego pasamos al análisis de los mitos que se generaron en torno a la enfermedad y, por último, tratamos de entender cómo estos generaron una la conformación de un grupo social particular en esos mismos sanatorios (AU)
Tuberculosis was a stigmatized disease, with a strong social meaning developed by medicine itself. In this paper, we make an analysis of the medical conceptions about the disease, and their repercussions on patients in a special place such as tuberculosis sanatoriums. In the first place, we enumerate the sanatoriums in the province of Cordoba, after that, we study the medical views about the sanatoriums and the infection, as a central element for hospitalized patients with tuberculosis. Later, we analyze the myths generated around the disease, and finally, we try to understand how these myths made possible to create a particular social group within those sanatoriums (AU)
Asunto(s)
Historia del Siglo XX , Hospitales/historia , Control de Infecciones/economía , Control de Infecciones/historia , Salud Pública/economía , Salud Pública/educación , Salud Pública/historia , Alienación Social/psicología , Estereotipo , Tuberculosis/economía , Tuberculosis/etnología , Tuberculosis/historia , Tuberculosis/psicología , Argentina/etnología , Hospitales de Aislamiento/economía , Hospitales de Aislamiento/historia , Profesionales para Control de Infecciones/economía , Profesionales para Control de Infecciones/educación , Profesionales para Control de Infecciones/historia , Profesionales para Control de Infecciones/psicologíaRESUMEN
For the presented study a computer-based surveillance system for detecting nosocomial infections (NI) with direct data input from attending on-ward physicians was implemented. During a 12-month period surveillance of ventilator-associated pneumonia (VAP) and catheter-associated bloodstream infections (BSI) was performed prospectively by on-ward physicians guided by infection control specialists on an 11-bed medical intensive care unit in a German university hospital. In 603 patients 3282 patient days were assessed. Completeness of data entry during the routine phase was 94% for ventilator days and 88% for central venous catheter days. The concordance of infection detection by automated evaluation and evaluation based clinical considerations was fairly good and was quantified by kappa measures of 0.49 for VAP and 0.57 for BSI. Detected infection rates ranged within the German national reference data. Personnel costs for on-ward physicians and infection control personnel were 1.01 Euro per device day in the routine phase. Time expenditure of less than 3 min per device day, rendered in about equal parts by physicians and infection control personnel, was lower than in studies relying on on-ward assessment by infection control personnel.
Asunto(s)
Infección Hospitalaria/prevención & control , Sistemas de Apoyo a Decisiones Clínicas , Contaminación de Equipos , Implementación de Plan de Salud/economía , Vigilancia de la Población/métodos , Cateterismo Venoso Central/efectos adversos , Costos y Análisis de Costo , Infección Hospitalaria/epidemiología , Infección Hospitalaria/etiología , Recolección de Datos/métodos , Sistemas de Apoyo a Decisiones Clínicas/economía , Alemania/epidemiología , Costos de Hospital , Humanos , Profesionales para Control de Infecciones/economía , Unidades de Cuidados Intensivos , Médicos/economía , Neumonía Asociada al Ventilador/epidemiología , Neumonía Asociada al Ventilador/prevención & control , Estudios Prospectivos , Sepsis/epidemiología , Sepsis/etiología , Sepsis/prevención & controlRESUMEN
Tuberculosis was a stigmatized disease, with a strong social meaning developed by medicine itself. In this paper, we make an analysis of the medical conceptions about the disease, and their repercussions on patients in a special place such as tuberculosis sanatoriums. In the first place, we enumerate the sanatoriums in the province of Cordoba, after that, we study the medical views about the sanatoriums and the infection, as a central element for hospitalized patients with tuberculosis. Later, we analyze the myths generated around the disease, and finally, we try to understand how these myths made possible to create a particular social group within those sanatoriums.
Asunto(s)
Hospitales , Control de Infecciones , Salud Pública , Alienación Social , Estereotipo , Tuberculosis , Argentina/etnología , Historia del Siglo XX , Hospitales/historia , Hospitales de Aislamiento/economía , Hospitales de Aislamiento/historia , Control de Infecciones/economía , Control de Infecciones/historia , Profesionales para Control de Infecciones/economía , Profesionales para Control de Infecciones/educación , Profesionales para Control de Infecciones/historia , Profesionales para Control de Infecciones/psicología , Salud Pública/economía , Salud Pública/educación , Salud Pública/historia , Alienación Social/psicología , Tuberculosis/economía , Tuberculosis/etnología , Tuberculosis/historia , Tuberculosis/psicologíaRESUMEN
OBJECTIVE: To assess consumption of resources in the infection control management of healthcare workers (HCWs) exposed to pertussis and to assess avoidability of exposure. SETTING: Tertiary care children's medical center. METHODS: Analysis of the extent of and reasons for HCW exposure to pertussis during contact with children with the disease, whether exposures were avoidable (because of the failure to recognize a case or to order or adhere to isolation precautions) or unavoidable (because the case was not recognizable or because another diagnosis was confirmed), and the cost of implementing exposure management. INTERVENTIONS: Interventions consisted of an investigation of every HCW encounter with any patient who was confirmed later to have pertussis from the time of hospital admission of the patient, use of azithromycin as postexposure prophylaxis (PEP) for exposed HCWs, performance of 21-day surveillance for cough illness, testing of symptomatic exposed HCWs for Bordetella pertussis, and enhanced preexposure education of HCWs. RESULTS: From September 2003 through April 2005, pertussis was confirmed in 28 patients (median age, 62 days); 24 patients were admitted. For 11 patients, pertussis was suspected, appropriate precautions were taken, and no HCW was exposed. Inadequate precautions for 17 patients led to 355 HCW exposures. The median number of HCWs exposed per exposing patient was 9 (range, 1-86 HCWs; first quartile mean, 2; fourth quartile mean, 61). Exposure was definitely avoidable for only 61 (17%) of 355 HCWs and was probably unavoidable for 294 HCWs (83%). The cost of 20-month infection control management of HCWs exposed to pertussis was $69,770. The entire cohort of HCWs involved in direct patient care at the facility could be immunized for approximately $60,000. CONCLUSIONS: Exposure of HCWs to pertussis during contact with children who have the disease is largely unavoidable, and management of this exposure is resource intensive. Universal preexposure vaccination of HCWs is a better utilization of resources than is case-based postexposure management.
Asunto(s)
Profilaxis Antibiótica/economía , Eficiencia Organizacional/economía , Profesionales para Control de Infecciones/economía , Control de Infecciones/economía , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/economía , Exposición Profesional/economía , Tos Ferina/prevención & control , Bordetella pertussis/inmunología , Bordetella pertussis/aislamiento & purificación , Bordetella pertussis/patogenicidad , Costos y Análisis de Costo , Servicio de Urgencia en Hospital/normas , Técnica del Anticuerpo Fluorescente Directa/economía , Hospitales Pediátricos , Humanos , Lactante , Control de Infecciones/normas , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Capacitación en Servicio/economía , Unidades de Cuidado Intensivo Pediátrico/normas , Exposición Profesional/prevención & control , Personal de Hospital/economía , Philadelphia , Precauciones Universales/métodos , Tos Ferina/diagnóstico , Tos Ferina/economíaAsunto(s)
Resistencia a Medicamentos , Hospitales , Profesionales para Control de Infecciones , Control de Infecciones , Agencias Internacionales , Enfermeras y Enfermeros , Salud Pública , Síndrome de Inmunodeficiencia Adquirida/etnología , Síndrome de Inmunodeficiencia Adquirida/historia , Animales , Desinfección/economía , Desinfección/historia , Desinfección/legislación & jurisprudencia , Resistencia a Medicamentos/fisiología , VIH , Fiebre Hemorrágica Ebola/etnología , Fiebre Hemorrágica Ebola/historia , Hepatitis B/etnología , Hepatitis B/historia , Historia de la Enfermería , Historia del Siglo XX , Hospitales/historia , Hospitales de Aislamiento/historia , Control de Infecciones/economía , Control de Infecciones/historia , Control de Infecciones/legislación & jurisprudencia , Profesionales para Control de Infecciones/economía , Profesionales para Control de Infecciones/educación , Profesionales para Control de Infecciones/historia , Profesionales para Control de Infecciones/legislación & jurisprudencia , Profesionales para Control de Infecciones/psicología , Agencias Internacionales/historia , Enfermedad del Virus de Marburg/historia , Enfermeras y Enfermeros/economía , Enfermeras y Enfermeros/legislación & jurisprudencia , Enfermeras y Enfermeros/psicología , Salud Pública/economía , Salud Pública/educación , Salud Pública/historia , Salud Pública/legislación & jurisprudencia , Práctica de Salud Pública/economía , Práctica de Salud Pública/historia , Sudáfrica/etnologíaAsunto(s)
Infección Hospitalaria/epidemiología , Control de Infecciones/métodos , Antibacterianos/uso terapéutico , Infección Hospitalaria/economía , Infección Hospitalaria/etiología , Revisión de la Utilización de Medicamentos , Hospitales Públicos , Humanos , Incidencia , Control de Infecciones/economía , Profesionales para Control de Infecciones/economía , Personal de Enfermería en Hospital/economía , Reino Unido/epidemiologíaRESUMEN
Infection control (IC) services in the United Kingdom are provided as part of the microbiology services and therefore they have not, to date, been costed separately. This paper addresses the cost of providing the service, the savings that accrue from the IC policies in a hospital and, finally, the cost of infective episodes and outbreaks. The point of the exercise is to enable readers to cost their own services and separate the IC and microbiology budgets while maintaining the provision of service under one department.