A cost-benefit analysis of gown use in controlling vancomycin-resistant Enterococcus transmission: is it worth the price?
Summary (2 min read)
Study Population
- During the 12 months between these two periods, gowns were not required.
- The institutional review board committees of Saint Louis University and Washington University approved this study.
- During the entire study period, all patients were actively screened for VRE by collection of stool for cultures or rectal swabs on admission, every 7 days, and at discharge from the MICU.
- Two patients without VRE were randomly selected, using the same matching criteria, for each patient with VRE bacteremia.
Costs
- Overall costs for the VRE surveillance and infection control program were estimated using the hospital’s step- down cost allocation system, which recorded line-item cost data per resource consumed and total cost per hospital admission.
- The cost for each isolation cart included all initial supplies.
- Observational time trials were used to estimate the time required for healthcare workers to retrieve, don, doff, and properly dispose of gowns.
- 18 To estimate the cost associated with excess workload per VRE patient contact, the average time was multiplied by the average registered nurse salary (excluding fringe benefits).
- Microbiology costs for each patient were obtained from line-item reports from the hospital’s microbiology database.
Decision Analysis
- The costs, benefits, and net benefit for the enhanced infection control and VRE surveillance programs are listed in Table 3.
- The incremental cost per case of VRE colonization averted was $1,897.
Sensitivity Analysis
- Several parameters were changed to determine the impact of their four main assumptions on the net benefit of gowns.
- The results were most sensitive to the probability of acquiring enteric VRE.
- Specifically, gowns are more likely to impact transmission when there are high rates of VRE colonization compared with when there are low rates.
Statistical Analysis
- Univariate statistics were obtained using SPSS software (version 10.0; SPSS, Inc., Chicago, IL).
- Differences in characteristics between patients with and patients without VRE were identified using t tests for continuous covariates and chi-square tests for categorical covariates.
- A Decision Tree Add-In for Microsoft Excel was used for the decision analysis (TreePlan, version 1.62; Microsoft Corp., Redmond, WA).
Matched Cohort
- Based on the matching criteria, patients with and patients without VRE were closely matched.
- The mean APACHE II scores were similar between patients colonized with VRE and their matched controls and between patients with VRE bacteremia and their matched controls (22.0 vs 21.8 and 26.5 vs 26.3, respectively), as were the mean ages (62.3 vs 62.2 years and 65.4 vs 64.0 years, respectively).
- An event pathway showing vancomycin-resistant enterococci (VRE) colonization and infection rates from July 1, 1997, to December 31, 1999, for patients in the medical intensive care unit.
Primary Outcomes
- The length of MICU stay, length of hospital stay, MICU costs, and hospital costs attributable to VRE were less for patients colonized with VRE than for patients with VRE bacteremia (Table 2).
- Five patients in the latter group died while hospitalized.
DISCUSSION
- The results of this cost–benefit analysis provide evidence that gown use adds costs to the delivery of health services in a MICU setting, but the benefits from averting enteric VRE transmission outweigh those costs.
- The increased cost associated with gown use needs to be considered relative to the attributable length of stay, mortality, and costs associated with VRE acquisition.
- There are several limitations to this study.
- The limitation that biases the study toward finding gowns to be cost-saving relates to the fact that the infection control protocols for this study were already in place at this insti- tution prior to the start of the study.
- The authors would have been potentially able to determine the number of secondary cases of VRE generated from a primary case of VRE and more accurately quantify the number of VRE cases averted.
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Citations
55 citations
Cites background from "A cost-benefit analysis of gown use..."
...92 each).[36] The cost of environmental decontamination, which included both costs of the cleaning agents and personnel time, consisted of routine daily cleaning ($22....
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...60 [36] Environmental cleaning Routine daily cleaning BASE $17....
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Cites background or methods from "A cost-benefit analysis of gown use..."
...By applying excess cost estimates for colonization and bacteremia, adjusted to 2003 dollars,(40) and varying the VRE transmission rate, prevention of colonization by use of CAS would have an estimated cost savings ranging from $35,401 to $230,307 per month, relative to the cost associated with the LAS method (Table 5).(5,21,25) Assuming that 1 case patient with VRE transmits VRE to 1 other person and that, of those colonized with VRE, between 8% and 13% become VRE bacteremic, the estimated cost savings attributable to prevented bacteremia ranges from $20,857 to $73,027 per month....
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...MICU, medical intensive care unit. a From Montecalvo et al.40 b From Puzniak et al.25 c From Carmelli et al.13 d From Stosor et al.8 the patients for whom a discharge surveillance test was not performed, 381 (43...
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...b From Puzniak et al.(25) c From Carmelli et al....
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...Because enteric colonization with van- VRE-related morbidity and mortality in populations at highcomycin-resistant enterococci (VRE) is an important risk fac- risk for VRE acquisition.(5,6,23,25)"(28) tor for VRE infection, prevention of colonization through A variety of active and passive surveillance methods have identification of others who are colonized, followed by im- been used for detection of enteric VRE....
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45 citations
Additional excerpts
...patients with vancomycin-resistant enterococci [3]....
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