Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-12-01T04:01:06.241Z Has data issue: false hasContentIssue false

Modeling the Costs of Hospital-Acquired Infections in New Zealand

Published online by Cambridge University Press:  02 January 2015

Nicholas Graves*
Affiliation:
Centre for Health Care Related Infection Surveillance and Prevention, Princess Alexandra Hospital, and the School of Public Health, Queensland University of Technology, Queensland, Australia
Tanya M. Nicholls
Affiliation:
Auckland District Health Board, Infection Control Service, Auckland, New Zealand
Arthur J. Morris
Affiliation:
Auckland District Health Board, Infection Control Service, Auckland, New Zealand
*
School of Public Health, QUT, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

To model the economic costs of hospital-acquired infections (HAIs) in New Zealand, by type of HAI.

Design:

Monte Carlo simulation model.

Setting:

Auckland District Health Board Hospitals (DHBH), the largest publicly funded hospital group in New Zealand supplying secondary and tertiary services. Costs are also estimated for predicted HAIs in admissions to all hospitals in New Zealand.

Patients:

All adults admitted to general medical and general surgical services.

Method:

Data on the number of cases of HAI were combined with data on the estimated prolongation of hospital stay due to HAI to produce an estimate of the number of bed days attributable to HAI. A cost per bed day value was applied to provide an estimate of the economic cost. Costs were estimated for predicted infections of the urinary tract, surgical wounds, the lower and upper respiratory tracts, the bloodstream, and other sites, and for cases of multiple sites of infection. Sensitivity analyses were undertaken for input variables.

Results:

The estimated costs of predicted HAIs in medical and surgical admissions to Auckland DHBH were $10.12 (US $4.56) million and $8.64 (US $3.90) million, respectively. They were $51.35 (US $23.16) million and $85.26 (US $38.47) million, respectively, for medical and surgical admissions to all hospitals in New Zealand.

Conclusions:

The method used produces results that are less precise than those of a specifically designed study using primary data collection, but has been applied at a lower cost. The estimated cost of HAIs is substantial, but only a proportion of infections can be avoided. Further work is required to identify the most cost-effective strategies for the prevention of HAI.

Type
Orginal Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

References

1.Haley, RW, Schaberg, DR, Crossley, KB, Von Allmen, SD, McGowan, JE Jr. Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med 1981;70:5158.Google Scholar
2.Rubinstein, E, Green, M, Modan, M, Amit, P, Bernstein, L, Rubenstein, AThe effect of nosocomial infections on the length and costs of hospital stay. J Antimicrob Chemother 1982;9(suppl A):93100.Google Scholar
3.Scheckler, WE. Hospital costs of nosocomial infections: a prospective three-month study in a community hospital. Infect Control 1980;1:150152.CrossRefGoogle Scholar
4.Fekerty, FR. The epidemiology of infections in surgical patients. In: Control of Infections in Hospitals: Proceedings of an Institute Held at the University of Michigan, March 1-3, 1965. Ann Arbor, MI: University of Michigan School of Public Health; 1965.Google Scholar
5.Kirkland, K, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725730.Google Scholar
6.Sperry, HE, Craddock, J. It pays to spend money for infection control. Modern Hospital 1968;111:124128.Google Scholar
7.Thoburn, R, Fekety, FR Jr, Cluff, LE, Melvin, VB. Infections acquired by hospitalized patients: an analysis of the overall problem. Arch Intern Med 1968;121:110.Google Scholar
8.Green, M, Rubenstein, E, Amit, P. Estimating the effects of nosocomial infections on the length of hospitalization. J Infect Dis 1982;145:667672.Google Scholar
9.Freeman, J, Rosner, BAMcGowan, JE Jr. Adverse effects of nosocomial infection. J Infect Dis 1979;140:732740.CrossRefGoogle ScholarPubMed
10.Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methi-cillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408411.Google Scholar
11.Digiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160:976981.CrossRefGoogle ScholarPubMed
12.Rose, R, Hunting, KJ, Townsend, TR, Wenzel, RP. Morbidity/mortality and economics of hospital-acquired blood stream infections: a controlled study. South Med J 1977;70:12671269.Google Scholar
13.Pittet, D, Tarara, D, Wenzel, RPNosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs and attributable mortality. JAMA 1994;271:15981601.CrossRefGoogle ScholarPubMed
14.Spengler, RF, Greenough, WB. Hospital costs and mortality attributed to nosocomial bacteremias. JAMA 1978;240:24552458.Google Scholar
15.Scheckler, WE. Septicemia and nosocomial infections in a community hospital. Ann Intern Med 1978;89:754756.Google Scholar
16.Clarke, S. Sepsis in surgical wounds, with particular reference to Staphylococcus aureus. Br J Surg 1957;44:592596.CrossRefGoogle ScholarPubMed
17.Coello, R, Glenister, H, Fereres, J. The cost of infection in surgical patients: a case-control study. J Hosp Infect 1993;25:239250.Google Scholar
18.Plowman, RP, Graves, N, Griffin, MA, The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialties of a district general hospital in England and the national burden imposed. J Hosp Infect 2001;47:198209.Google Scholar
19.Lowenthal, J. Sources and sequelae of surgical sepsis. BMJ 1962;2:14371440.Google Scholar
20.Mugford, M, Kingston, J, Chalmers, I. Reducing the incidence of infection after caesarean section: implications of prophylaxis with antibiotics for hospital resources. BMJ 1989;299:10031006.Google Scholar
21.Davies, T, Cottingham, J. The cost of hospital infection in orthopedic patients. J Infect 1979;1:330338.CrossRefGoogle Scholar
22.Kappstein, I, Schulgen, G, Fraedrich, G, Schlosser, V, Schumacher, M, Daschner, FD. Added hospital stay due to wound infections following cardiac surgery. Thorac Cardiovasc Surg 1992;40:148151.Google Scholar
23.Schafer, U. Cost analysis in nosocomial infections: a 1-year study in the surgical department of Riesa District Hospital [in German]. Zentralbl Chir 1987;112:15521560.Google Scholar
24.Poulsen, KB, Bremmelgaard, A, Sorensen, AI, Raahave, D, Petersen, JV. Estimated costs of postoperative wound infections: a case-control study of marginal hospital and social security costs. Epidemiol Infect 1994;113:282295.Google Scholar
25.Pena, C, Pujol, M, Pallares, R, et al.Estimation of costs attributable to nosocomial infection: prolongation of hospitalization and calculation of alternative costs. Medicina Clinica 1996;106:441444.Google ScholarPubMed
26.Medina, M, Martinez-Gallego, G, Sillero-Arenas, M, Delgado-Rodriguez, M. Risk factors and length of stay attributable to hospital infections of the urinary tract in general surgery patients. Enferm Infecc Microbiol Clin 1997;15:310314.Google ScholarPubMed
27.Li, LY, Wang, SQ. Economic effects of nosocomial infections in cardiac surgery. J Hosp Infect 1990;16:339341.Google Scholar
28.Simchen, E, Sacks, T. Infection in war wounds: experience during the 1973 October War in Israel. Ann Surg 1975;182:754761.Google Scholar
29.Girard, R, Fabry, J, Meynet, R, Lambert, DC, Sepetjan, M. Costs of nosocomial infection in a neonatal unit. J Hosp Infect 1983;4:361366.Google Scholar
30.Haley, RW. Cost benefit analysis of infection control activities. In: Brachman, P, Bennett, V, eds. Hospital Infections. Boston: Little, Brown; 1992:507532.Google Scholar
31.Plowman, RP, Graves, N, Roberts, JAHospital Acquired Infection. London: Office of Health Economics; 1997.Google Scholar
32.Nicholls, TM, Morris, AJ. Nosocomial infection in Auckland Healthcare hospitals. NZMed J 1997;110:314316.Google Scholar
33.Graves, N, Nicholls, TM, Wong, CGS, Morris, AJ. The prevalence and estimates of the cumulative incidence of hospital-acquired infections among patients admitted to Auckland District Health Board Hospitals in New Zealand. Infect Control Hosp Epidemiol 2003;24:5661.CrossRefGoogle ScholarPubMed
34.Plowman, RRGraves, N, Griffin, M, et al.The Socioeconomic Burden of Hospital Acquired Infection. London: Public Health Laboratory Service; 1999.Google Scholar
35.Palisade Corporation. @RISK, Risk Analysis Add-in for Microsoft Excel. New York: Palisade Corp.; 2000.Google Scholar
36.Rhame, F, Sudderth, W. Incidence and prevalence as used in the analysis of the occurrence of nosocomial infections. Am J Epidemiol 1981;113:111.CrossRefGoogle ScholarPubMed
37.Delgado-Rodriguez, M, Cueto Espinar, A, Rodriguez-Contneras Pelayo, R, Galvez Vargas, RA practical application of Rhame and Sudderth's formula on nosocomial infection surveillance. Rev Epidemiol Sante Publique 1987;35:482487.Google Scholar
38.Gastmeier, P, Brauer, H, Sohr, D, et al.Converting incidence and prevalence data of nosocomial infections: results from eight hospitals. Infect Control Hosp Epidemiol 2001;22:3134.Google Scholar
39.Asensio, A, Torres, J. Quantifying excess length of postoperative stay attributable to infections: a comparison of methods. J Clin Epidemiol 1999;52:12491256.Google Scholar
40.McGowan, JE. Cost and benefit: a critical issue for hospital infection control. Am J Infect Control 1982;10:100108.Google Scholar
41.Haley, RW, Schaberg, DR, Von Allmen, SD, McGowan, JE Jr. Estimating the extra charges and prolongation of hospitalization due to nosocomial infections: a comparison of methods. J Infect Dis 1980;141:248257.CrossRefGoogle ScholarPubMed
42.Haley, RW. Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. Am J Med 1991;91 (suppl 3B):32S38S.Google Scholar
43.Mellet, HM, Harries, NS. Costs and the costing process. In: Mellet, H, ed. Financial Management in the NHS: A Manager's Handbook. London: Chapman & Hall; 1993.Google Scholar
44.Haley, RW, Culver, DH, White, JW, et al.The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182205.Google Scholar
45.National Audit Office. The Management and Control of Hospital Acquired Infection in Acute NHS Trusts in England: Executive Summary and Recommendations. London: HMSO; 2000. Available at www.nao.gov.uk/guidance/chiefexeclc.htm.Google Scholar
46.Graves, N. Estimating the Economic Effects of Hospital Acquired Infection [PhD thesis]. London: University of London; 2002.Google Scholar
47.Kappstein, I, Schulgen, G, Beyer, U, et al.Prolongation of stay and extra cost due to ventilator-associated pneumonia in an intensive care unit. Eur J Clin Microbiol Infect Dis 1992;11:504508.Google Scholar
48.Li, LY, Wang, SQ. A prospective study of nosocomial infections in cardiac surgery patients in China. Am J Infect Control 1990;18:365370.Google Scholar
49.Green, J, Wenzel, RRPostoperative wound infection: a controlled study of the increased duration of hospital stay and direct cost of hospitalization. Ann Surg 1977;185:264268.Google Scholar