Hand hygiene noncompliance and the cost of hospital-acquired methicillin-resistant Staphylococcus aureus infection.
Abstract
BACKGROUND: Hand hygiene noncompliance is a major cause of nosocomial infection. Nosocomial
infection cost data exist, but the effect of hand hygiene noncompliance is unknown.
OBJECTIVE: To estimate methicillin-resistant Staphylococcus aureus (MRSA)-related
cost of an incident of hand hygiene noncompliance by a healthcare worker during patient
care. DESIGN: Two models were created to simulate sequential patient contacts by a
hand hygiene-noncompliant healthcare worker. Model 1 involved encounters with patients
of unknown MRSA status. Model 2 involved an encounter with an MRSA-colonized patient
followed by an encounter with a patient of unknown MRSA status. The probability of
new MRSA infection for the second patient was calculated using published data. A simulation
of 1 million noncompliant events was performed. Total costs of resulting infections
were aggregated and amortized over all events. SETTING: Duke University Medical Center,
a 750-bed tertiary medical center in Durham, North Carolina. RESULTS: Model 1 was
associated with 42 MRSA infections (infection rate, 0.0042%). Mean infection cost
was $47,092 (95% confidence interval [CI], $26,040-$68,146); mean cost per noncompliant
event was $1.98 (95% CI, $0.91-$3.04). Model 2 was associated with 980 MRSA infections
(0.098%). Mean infection cost was $53,598 (95% CI, $50,098-$57,097); mean cost per
noncompliant event was $52.53 (95% CI, $47.73-$57.32). A 200-bed hospital incurs $1,779,283
in annual MRSA infection-related expenses attributable to hand hygiene noncompliance.
A 1.0% increase in hand hygiene compliance resulted in annual savings of $39,650 to
a 200-bed hospital. CONCLUSIONS: Hand hygiene noncompliance is associated with significant
attributable hospital costs. Minimal improvements in compliance lead to substantial
savings.
Type
Journal articleSubject
Academic Medical CentersCross Infection
Guideline Adherence
Hand Disinfection
Health Personnel
Hospital Costs
Humans
Hygiene
Infection Control
Infectious Disease Transmission, Professional-to-Patient
Methicillin-Resistant Staphylococcus aureus
North Carolina
Staphylococcal Infections
Permalink
https://hdl.handle.net/10161/4141Published Version (Please cite this version)
10.1086/651096Publication Info
Cummings, Keith L; Anderson, Deverick J; & Kaye, Keith S (2010). Hand hygiene noncompliance and the cost of hospital-acquired methicillin-resistant
Staphylococcus aureus infection. Infect Control Hosp Epidemiol, 31(4). pp. 357-364. 10.1086/651096. Retrieved from https://hdl.handle.net/10161/4141.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Deverick John Anderson
Professor of Medicine
Hospital epidemiology, infection control, antibiotic stewardship, multidrug-resistant
organisms, device-related infections, surgical site infections, catheter-associated
bloodstream infections, cost of infections, infections in community hospitals

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