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A Cost-Benefit Analysis of Gown Use in Controlling Vancomycin-Resistant Enterococcus Transmission Is It Worth the Price?

Published online by Cambridge University Press:  02 January 2015

Laura A. Puzniak ,
Kathleen N. Gillespie ,
Terry Leet ,
Marin Kollef  and
Linda M. Mundy
Laura A. Puzniak
Affiliation:
Department of Community Health, St. Louis, Missouri
Kathleen N. Gillespie
Affiliation:
Department of Health Management and Policy, Saint Louis University School of Public Health, St. Louis, Missouri
Terry Leet
Affiliation:
Department of Community Health, St. Louis, Missouri
Marin Kollef
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Linda M. Mundy*
Affiliation:
Department of Community Health, St. Louis, Missouri Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
*
Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8051, St. Louis, MO 63110
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Abstract

Objective:

To determine the net benefit and costs associated with gown use in preventing transmission of van-comycin-resistant Enterococcus (VRE).

Design:

A cost-benefit analysis measuring the net benefit of gowns was performed. Benefits, defined as averted costs from reduced VRE colonization and infection, were estimated using a matched cohort study. Data sources included a step-down cost allocation system, hospital informatics, and microbiology databases.

Setting:

The medical intensive care unit (MICU) at Barnes-Jewish Hospital, St. Louis, Missouri.

Patients:

Patients admitted to the MICU for more than 24 hours from July 1, 1997, to December 31, 1999.

Interventions:

Alternating periods when all healthcare workers and visitors were required to wear gowns and gloves versus gloves alone on entry to the rooms of patients colonized or infected with VRE.

Results:

On base-case analysis, 58 VRE cases were averted with gown use during 18 months. The annual net benefit of the gown policy was $419,346 and the cost per case averted of VRE was $1,897. The analysis was most sensitive to the level of VRE transmission.

Conclusions:

Infection control policies (eg, gown use) initially increase the cost of health services delivery. However, such policies can be cost saving by averting nosocomial infections and the associated costs of treatment. The cost savings to the hospital plus the benefits to patients and their families of avoiding nosocomial infections make effective infection control policies a good investment.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 5 , May 2004 , pp. 418 - 424
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Hospital Infections Program, National Nosocomial Infections Surveillance (NNIS) System. National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1990-May 1999, issued June 1999. Atlanta, GA: National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services; 1999.Google Scholar
2.Centers for Disease Control and Prevention. Staphylococcus aureus resistant to vancomycin: United States, 2002. MMWR 2002;51:565–567.Google Scholar
3.Miller, D. Public Health Dispach: vancomycin-resistant Staphylococcus aureus, Pennsylvania 2002. MMWR 2002;51:902.Google Scholar
4.Smith, TL, Pearson, ML, Wilcox, KR, et al.Emergence of vancomycin resistance in Staphylococcus aureus. N Engl J Med 1999;340:493–501.CrossRefGoogle ScholarPubMed
5.Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HIC-PAC). MMWR 1995;44(RR-12):1–13.Google Scholar
6.Slaughter, S, Hayden, MK, Nathan, C, et al.A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med 1996;125:448–456.CrossRefGoogle Scholar
7.Montecalvo, MA, Jarvis, WR, Uman, J, et al.Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting. Ann Intern Med 1999;121:269–272.Google Scholar
8.Boyce, JM, Opal, SM, Chow, JW, et al.Outbreak of multi-drug resistant Enterococcus faecium with transferable van B class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.Google Scholar
9.Patterson, P. Is a cover gown policy worth the cost and effort? OR Manager 1989;5:6–7.Google Scholar
10.Pelke, S, Ching, D, Easa, D, et al.Gowning does not affect colonization or infection rates in a neonatal intensive care unit. Arch Pediatr Adolesc Med 1994;148:1016–1020.Google Scholar
11.Duquette-Petersen, L, Francis, ME, Dohnalek, L, et al.The role of protective clothing in patients undergoing autologous bone marrow transplantation. Oncol Nurs Forum 1999;26:1319–1324.Google ScholarPubMed
12.Lai, KK, Kelley, AL, Melvin, ZS, et al.Failure to eradicate vancomycin-resistant enterococci in a university hospital and the cost of barrier precautions. Infect Control Hosp Epidemiol 1998;19:647–652.Google Scholar
13.Puzniak, LA, Leet, T, Mayfield, J, et al.To gown or not to gown: the impact of gowns on VRE acquisition. Clin Infect Dis 2002;35:18–25.Google Scholar
14.Golan, Y, Snydman, DR. Reduced acquisition of vancomycin-resistant enterococci: gown effect or confounding? Clin Infect Dis 2003;36:535–536.Google Scholar
15.Puzniak, LA, Leet, T, Mayfield, J, et al.Reduced acquisition of vancomycin resistant enterococci: gown effect or confounding? Clin Infect Dis 2003;36:537–538. Letter.Google Scholar
16.Knaus, WA, Draper, EA, Wagner, DP, et al.APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.Google Scholar
17.Haley, RW. Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. Am J Med 1991;91(suppl 3B):32S–38S.Google Scholar
18.Papia, G, Louie, M, Tralla, A, et al.Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost effective? Infect Control Hosp Epidemiol 1999;20:473–477.Google Scholar
19.Drummond, MF, O'Brien, B, Stoddart, GL, et al.Methods for the Economic Evaluation of Health Care Programmes, ed. 2. Oxford: Oxford University Press; 1997.Google Scholar
20.Leber, A, Hindler, JF, Kato, EO, et al.Laboratory-based surveillance for vancomycin-resistant enterococci: utility of screening stool specimens submitted for Clostridium difficile toxin assay. Infect Control Hosp Epidemiol 2001;22:160–164.Google Scholar
21.Hacek, DM, Bednarz, P, Noskin, GA, et al.Yield of vancomycin-resistant enterococci and multi-drug resistant enterobacteriaceae from stools submitted for Clostridium difficile testing compared to results from a focused surveillance program. J Clin Microbiol 2001;39:1152–1154.Google Scholar
22.Dembek, ZF, Kellerman, SE, Ganley, L, et al.Reporting of vancomycin-resistant enterococci in Connecticut: implementation and validation of a state-based surveillance system. Infect Control Hosp Epidemiol 1999;20:671–675.Google Scholar
23.Katz, KC, Gardam, MA, Burt, J, et al.A comparison of multifaceted versus Clostridium difficile-focused VRE surveillance strategies in a low-prevalence setting. Infect Control Hosp Epidemiol 2001;22:219–221.Google Scholar
24.Bonten, MJ, Weinstein, RA. The role of colonization in the pathogenesis of nosocomial infections. Infect Control Hosp Epidemiol 1996;17:193–200.Google Scholar
25.Roghmann, MC, McCarter, RJ Jr, Brewrink, J, et al.Clostridium difficile infection is a risk factor for bacteremia due to vancomycin-resistant enterococci (VRE) in VRE-colonized patients with acute leukemia. Clin Infect Dis 1997;25:1056–1059.Google Scholar
26.Montecalvo, MA, Horowitz, H, Gedris, C, et al.Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994;38:1363–1367.Google Scholar
27.Boyce, JM. Treatment and control of colonization in the prevention of nosocomial infections. Infect Control Hosp Epidemiol 1996;17:256–261.CrossRefGoogle ScholarPubMed
28.Zaas, AK, Song, X, Tucker, P, et al.Risk factors for development of vancomycin-resistant enterococcal bloodstream infection in patients with cancer who are colonized with vancomycin-resistant enterococci. Clin Infect Dis 2002;35:1139–1146.Google Scholar
29.Byers, KE, Anglim, AM, Anneski, CJ, et al.A hospital epidemic of vancomycin-resistant Enterococcus: risk factors and control. Infect Control Hosp Epidemiol 2001;22:140–147.Google Scholar
30.Webb, M, Riley, LW, Roberts, RB. Cost of hospitalization for and risk factors associated with vancomycin-resistant Enterococcus faecium infection and colonization. Clin Infect Dis 2001;33:445–452.Google Scholar
31.Holmberg, SD, Solomon, SL, Blake, PA. Health and economic impacts of antimicrobial resistance. Reviews of Infectious Diseases 1987;9:1065–1078.Google Scholar
32.Niederman, MS. Impact of antibiotic resistance on clinical outcomes and the cost of care. Crit Care Med 2001;29:N114–N120.Google Scholar
33.Landry, S, Kaiser, DL, Wenzel, RP. Hospital stay and mortality attributed to nosocomial enterococcal bacteremia: a controlled study. Am J Infect Control 1989;17:323–329.Google Scholar
34.Muto, CA, Giannetta, ET, Durbin, LJ, et al.Cost-effectiveness of perirectal surveillance cultures for controlling vancomycin-resistant Enterococcus. Infect Control Hosp Epidemiol 2002;23:429–435.Google Scholar
35.Carmeli, Y, Eliopoulos, G, Mozaffari, E, et al.Health and economic outcomes of vancomycin resistant Enterococcus. Arch Intern Med 2002;162:2223–2228.Google Scholar
36.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.Google Scholar
37.McGowan, JE. Cost and benefit in control of nosocomial infection: methods for analysis. Reviews of Infectious Diseases 1981;3:790–797.Google Scholar
38.Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost and prevention. Infect Control Hosp Epidemiol 1996;17:552–557.CrossRefGoogle ScholarPubMed
39.Wilcox, MH, Dave, J. The cost of hospital-acquired infection and the value of infection control. J Hosp Infect 2000;45:81–84.Google Scholar
40.Linden, PK, Miller, CB. Vancomycin-resistant enterococci: the clinical effect of a common nosocomial pathogen. Diagn Microbiol Infect Dis 1999;33:113–120.Google Scholar
41.Meit, SS, Williams, D, Mencken, FC, et al.Gowning: effects on patient satisfaction. J Fam Pract 1997;45:397–401.Google Scholar
42.Nardone, DA, James, KE, Finck, L. Impact of gowning on visit length and physical examinations. J Gen Intern Med 1998;13:489–490.CrossRefGoogle ScholarPubMed
43.Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290:1899–1905.Google Scholar
44.Mayhall, CG. Control of vancomycin-resistant enterococci: it is important, it is possible, and it is cost-effective. Infect Control Hosp Epidemiol 2002;23:421–423.Google Scholar
45.Bonten, MJ, Slaughter, S, Ambergen, AW, et al.The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 1998;158:1127–1132.Google Scholar
46.Krahn, M, Detsky, AS. Should Canada and the United States universally vaccinate infants against hepatitis B? A cost-effectiveness analysis. Med Decis Making 1993;13:4–20.Google Scholar
47.Graham, JD, Corso, PS, Morris, JS, et al.Evaluating the cost-effectiveness of clinical and public health measures. Annu Rev Public Health 1998;19:125–152.Google Scholar
48.Azimi, NA, Welch, HG. The effectiveness of cost-effectiveness analysis in containing costs. J Gen Intern Med 1998;13:664–669.Google Scholar
49.Tucker, AW, Haddix, AC, Bresee, JS, et al.Cost-effectiveness analysis of a rotavirus immunization program for the United States. JAMA 1998;279:1371–1376.Google Scholar
50.Lieu, TA, Cochi, SL, Black, SB, et al.Cost-effectiveness of a routine varicella vaccination program for US children. JAMA 1994;271:375–381.Google Scholar
51.Sisk, JE, Moskowitz, AJ, Whang, W, et al.Cost effectiveness of vaccination against pneumococcal bacteremia among elderly people. JAMA 1997;278:1333–1339.Google Scholar
52.Margolis, HS, Coleman, PJ, Brown, RE, et al.Prevention of hepatitis B virus transmission by immunization. JAMA 1995;274:1201–1208.Google Scholar
53.Bloom, BS, Hillman, AL, Fendrisk, AM, et al.A reappraisal of hepatitis B virus vaccination strategies using cost-effectiveness analysis. Ann Intern Med 1993;118:298–306.Google Scholar