Healthcare-associated infections (HAIs) have a significant impact on hospitals and patients. For patients, HAIs can lead to increased treatment, extended hospital stays, disability and even death. Hospitals experience decreased productivity, litigation costs and damage to their reputation from HAIs. At a national level, HAIs contribute to increased healthcare costs and societal losses from inability to work. The document discusses the difficulties in measuring the full economic burden of HAIs but notes it has been shown to be substantial. Prevention of HAIs should be an important part of patient care due to their associated morbidity, mortality and costs.

1. Impact
of
HAIs
on
the
hospital
28-­‐02-­‐13
¤
Are
common
¤
Preven?on
should
be
integral
part
of
pa?ent
care
Andreas
Voss,
MD,
PhD
¤
Morbidity
and
mortality
(clinical
burden)
Professor
of
Infec?on
Control
RUNMC
&
CWZ
¤
High
financial
impact
(economic
burden)
Nijmegen,
The
Netherlands
² On
hospital
services
² On
costs
of
na?onal
health
care
¤ Pa?ent
¤
Measurement
is
difficult
² Addi?onal
diagnos?c
tests
and
treatment
² Extended
hospital
stay
¤
Financial
impact
varies
between
different
² Temporary/permanent
disability
(death)
healthcare-­‐se]ngs,
-­‐systems
and
countries
¤ Hospital
¤ “High
costs”
repeatedly
demonstrated
² Decreased
produc?on
(beds
blocked)
¤
Increased
awareness
with
regard
to
the
² Claims
and
li?ga?on
importance
of
infec?on
control
² Reimbursement
too
low
or
excluded
(DRG,
NI-­‐MRSA)
² Reputa?on/image
damage
(decrease
referrals)
¤ Society
¤ Added
value
of
individual
IC
components
“s<ll
² Loss
of
labor
unknown”
¤ The
es?mate
for
the
member
states
is
that
between
8%
en
12%
of
the
hospitalized
pa?ents
experience
unintended
complica?ons
¤ On
average
1
in
20
hospital
pa?ents
will
develop
a
NI
¤ In
the
EU:
4.1
miljoen
pa?ënten
per
year
resul?ng
in
the
death
of
37
000
pa?ents
Technical
report
"Improving
pa?ent
safety
in
the
EU",
drabed
the
Europeam
"Improving
pa<ent
safety
in
the
EU”
Commission,
published
in
2008
by
RAND
Corpora?on.
Rapport
for
the
European
Commission
Published
in
2008
by
RAND
Co.
Andreas
Voss,
MD,
PhD
1

2. Impact
of
HAIs
on
the
hospital
28-­‐02-­‐13
1.66/1,000
inhab.
10.000
GBD/case
60
mil
8.75/1,000
inhab.
4300
CHF/case
8
mil
Wilcox
MH,
Dave
J.
The
cost
HAI
and
the
value
of
infec?on
control.
J
Hosp
Infect
2000;45:81-­‐4
…
manda?ng
hospitals
to
publically
report
HAI
rates
and
a
federal
pay-­‐for-­‐performance
measure
that
will
no
longer
allow
Medicare
to
pay
more
for
pa?ents
with
HAIs
=
…
we
would
have
been
born
with
a
zipper
and
spare
parts
using
a
“click-­‐system”
Andreas
Voss,
MD,
PhD
2

3. Impact
of
HAIs
on
the
hospital
28-­‐02-­‐13
¤
Shame
&
guilt
¤
Hepa??s,
HIV
¤
STD-­‐pathogens,
HPV,
…
¤
TB,
respiratory-­‐viruses
¤
Teaching-­‐hospital
¤
Start
in
the
ICU
with
8
cases
in
December
2011
¤
560
beds,
32000
admissions/yr,
24000
day-­‐
²
SDD
as
possible
reason
admissions/yr,
OPC
for
the
larger
region
²
most
pa?ents
from
2
internal
medicine
units
(oncol
&
dialysis)
¤
3km
away
from
UMC
¤
Screening
of
the
2
medical
units:
¤
Full
microbiology
and
ID
service
(3.3
be)
VRE
prevalence
25%
¤
Infec?on
control
(2
x
0.5be
MD,
4.6
be
ICP)
¤
Prevalence
screening
hospital-­‐
wide:
4
other
units
with
high
¤
Regional
infec?on
control
prevalence
of
VRE
¤
Outbreak
management
team
(core)
¤
Environment
has
to
be
free
of
VRE
²
CEO,
head
IC,
chair
medical
staff,
coordina?ng
²
problem
bed-­‐pans
(washers)
&
commodes
unit
manager,
head
communica?on
¤
Handhygiene
needs
to
be
improved
¤
Outbreak
management
team
(large)
²
rings,
watches,
long
sleeves
²
Ini?ally
all
medical
and
nursing
heads
of
¤
All
pa?ents
on
correct
cohort
(VRE+,
-­‐,
?)
implemented
units
(must)
and
other
units
(can),
² Flagging
of
pa?ents
in
HIS
communica?on,
fascility
management
¤
Contact
isola?on
procedures
correct
²
Aber
3
months:
all
unit
managers
(n=22)
² “I
dont
know
how”
¤
All
HCWs
trained
² Up
to
70%
new
HCWs
on
some
units
Andreas
Voss,
MD,
PhD
3

4. Impact
of
HAIs
on
the
hospital
28-­‐02-­‐13
¤
All
“5-­‐steps”
are
monitored
per
department
on
a
weekly
base
¤
Feedback
in
weekly
OMT
with
managers
¤
Analysis
and
squeezing
in
weekly
core
OMT
¤
Monthy
rapport
to
na?onal
outbreak
group
²
all
outbreaks
need
to
be
rapported
²
several
stages
which
can
end
in
a
na?onal
team
taking
over
outbreak
control
¤
Roomservice
¤
Roomservice-­‐plus
¤
RN
¤
Nursing
assitent
¤
Cleaners
Vacant
Responsibility
!
Andreas
Voss,
MD,
PhD
4

5. Impact
of
HAIs
on
the
hospital
28-­‐02-­‐13
¤
Time
¤
Aber
2
x
prevalence
screening
(hospital
wide),
²
52
x
OMT
(x2
core
and
large)
weekly
screening
of
pa?ents
in
6
units
²
transfer
to
nurses
on
ward
²
100
training
sessions
“contact
isola?on”
²
using
in-­‐house
PCR
²
Monthly
up-­‐date
at
medical
staff
and
nursing
staff
¤
Cultures
from
the
environment
(bed-­‐pans
and
mee?ng
commodes,
if
visibly
soiled
at
audits)
²
several
leters
to
thousands
of
pa?ents,
internal
and
external
communica?on,
calling
center
¤
Typing
of
VRE-­‐isolates
(AFLP,
MLST)
¤
Produc?on
²
reduced
by
approx.
20%
on
6
wards
¤
Supplies
¤
EUR
2.000.000
²
excluding
loss
in
produc?on
² 10%
is
covered
by
insurance
June
25-­‐28,
2013
¤
Probably
no
“image
damage”
Geneva
Switzerland
²
one
of
10
hospitals
with
VRE
problem
²
open
communica?on,
na?onal
symposium
²
98%
coloniza?on,
overall
5
clinical
infec?ons
including
2
BSI
à
all
successfully
treated
with
www.icpic2013.com
teicoplanin
(vanB)
Andreas
Voss,
MD,
PhD
5