Nosocomial Prevention Programs Save Lives and Dollars

Programs to counter healthcare-associated infection (HAI) increase the odds of patient survival and reduce the cost of their care.

Researchers at the RAND Corporation (Pittsburgh, PA, USA), Columbia University (New York, NY, USA), and other institutions reviewed outcomes for 17,537 elderly Medicare patients admitted to 31 hospitals to assess the cost and effectiveness of HAI prevention efforts. The researchers then combined five years of follow-up Medicare data with HAI rates, cost and quality of life estimates, and health care expenditures with and without central line associated bloodstream infection (CLABSI) and/or ventilator-associated pneumonia (VAP).

The results showed that while 57% of all the elderly intensive care unit (ICU) patients died within five years, infections made death more likely. For example, 75% of those who developed CLABSI died within five years, as did 77% of those elderly patients who developed VAP. On the other hand, effective prevention programs for CLABSI resulted in an estimated gain of 15.55 years of life on average for all patients treated in the ICU. VAP prevention measures resulted in an estimated gain of 10.84 years of life on average.

As to expenditures, the researchers found that the ongoing cost of running an infection prevention program in the ICU is about USD 145,000. But the expense was overshadowed by the reductions in admission ICU costs as a result of effective HAI prevention programs, which were calculated at USD 174,713.09 for CLABSI and USD 163,090.54 for VAP, per patient, which was reflected in the incremental cost-effectiveness ratios (ICERs) per life year of the HAI prevention programs.

The study was published in the January 2015 issue of the American Journal of Infection Control.

“We've known for decades what works to prevent infections and save lives. Now, our study shows just how much money can be saved by investing in prevention,” concluded senior study author Patricia Stone, PhD, RN, director of the Center for Health Policy at Columbia University School of Nursing. “Multifaceted HAI prevention programs are cost-effective. Our results underscore the importance of maintaining ongoing investments in HAI prevention; the welfare benefits implied by the advantageous ICERs would be lost if the investments were suspended.”

Examples of effective prevention programs for CLABSI include such simple measures as hand washing before handling the catheter, and immediately changing the dressing around the central line if it gets wet or dirty. As to VAP, simply keeping patients elevated in bed, with the head higher than the feet, provides a simple precaution that can help prevent pneumonia.

Related Links:
RAND Corporation
Columbia University