New research shows HCAIs cost more than previously thought

By Richard Verdiramo

Recent research at Duke University in Durham, North Carolina has cast into question the figures usually cited for the cost of healthcare-associated infections (HCAIs), saying the actual amount probably is higher.

The dollar figure often cited for a single instance of HCAI in the U.S. is $12,000 to $35,000 (€8,743 to €25,499).

However, a recently published study by Deverick J. Anderson et al* showed that a single HCAI in very specific surgical sites can cost $60,000 (€43,713) more money than a group of similar, uninfected controls.

In addition, the study reported that HCAIs increase the risk of death seven-fold, not five, and lead to a 35 percent risk of readmission.

Their conclusions state that the cost would have been much higher had they used a more general patient population or more current data that would include the most recent increases in HCAIs, some 90 percent since 1999, according to the U.S. Centers for Disease Control.

Anderson et al. concluded that they based their research on two types of surgical-site infections (SSI): deep incisional and organ/space infections. However, they state that "... cost estimates would have been higher had they included superficial incisional infections in our analysis."

Because they only counted indirect in-hospital costs, saying again that their cost figures probably under-estimate the true financial impact of these "devastating infections."

The authors concluding by saying that "If an intervention costs less than $61,000 (€44,441) and leads to the prevention of only one SSI due to MRSA, then this intervention will likely be cost effective for the institution."

Research also has shown that hand-washing stops most HCAIs each year.

That simple act would potentially save 37,000 lives per year and stop 4.1 million infections in the European Union annually, according to a 2008 report from the European Centre for Disease Prevention and Control.

Easy access has been cited as one of the top reasons that busy doctors, nurses and other healthcare workers don't wash up every time they see a new patient.

A busy nurse might touch as many as 100 or 200 patients a shift. An emergency room doctor might deal with 100 patients per shift.

But, it's not only access or time that make a difference.

A recently released industry survey showed that lack of compliance also came from three larger cultural issues that were lacking:

• Willingness  to self-police or report colleague violations (40  percent),
• Making hand-hygiene a priority (29 percent),
• Having adequate penalties for non-compliance (19 percent).

Because HCAIs are seen as sporadic occurrences. Even healthcare workers do not necessarily connect them to a lack of hand-washing, especially their own.

In this regard, some older studies have shown that physicians may be the worst offenders.

Despite frequent patient contact, Bartzokas et al observed that senior doctors only washed their hands twice during 21 hours of ward rounds.

Pritchard and Raper also reported that doctors were the worst offenders, more lax than either nurses or aides. "Doctors can be so extraordinarily self-delusional about their behavior," they said.

While this may have changed in the past few years, self-reporting vastly overestimates compliance-a rate of 73 percent (50 to 95 percent range) during which researchers observed doctors washing up only 9 percent of the time.

Doctors are important because they set the tone of the culture in many hospitals.

If junior doctors see senior ones (or consultants) washing their hands, they continue to wash their hands, as trained. If, however, they notice that their superiors do not bother, their own behavior will become more lax.

A recent French study showed that anyone who does not wash their hands can spread infection. This is especially true of peripatetic workers, such as therapists.                  

Staff members who see every patient every day can spread infections three times faster than either doctors or nurses can. One such staff member's lack of hand-hygiene can bring down the compliance rate for the whole healthcare staff to only 77 percent.

Given these obstacles and the untold suffering of patients who acquire HCAIs, tracking and monitoring is an obvious solution.

Surveillance by individuals is not only too labor intensive, but it can be biased. To deal with this, HandGiene Corporation invented an RFID-enabled system for compliance monitoring for accountability.

Staff-and visitors, if desired-simply wear badges or wristbands with RFID sensors.

The individual tags are monitored by sensors that are part of an integrated system of soap or  hand-sanitizer dispensers and stand-alone RFID readers.

The HandGiene units deliver a propriety soap or hand-sanitizer that takes 15 seconds of friction to dissipate, decontaminating hands.

This new use of RFID allows administrators to zero in on anyone who is not complying with hand-hygiene protocols-and gives them a compliance data for education and training.

HandGiene's reporting system can be used to show overall rates or drill down to more specific information, as needed.

With the software, administrators easily can create documentation of hand-hygiene compliance rates to accrediting bodies or governmental agencies.

Although there are other monitoring products on the market, monitoring will not help if there is no easy access to hand-cleaning solutions. That was why HandGiene's  inventor, Vincent Verdiramo, created a complete system.

"It's been known for more than 150 years that hand-washing in healthcare is essential," said Verdiramo, HandGiene's President. "We wanted to make sure people washed their hands, but we also wanted make it easy for them to comply."

Because some C. difficile spores are resistant to alcohol, the hand-sanitizer solution is not alcohol-based. Alcohol-based hand-sanitizers also are very drying when used as often as one would in a healthcare setting. "We wanted our cleansing solutions to work on all bacteria and virus," said Verdiramo.

For more information, please call 00 353 87 635 2787 or visit  www.HandGieneCorp.eu.

*"Clinical and Financial Outcomes Due to Methicillin Resistant Staphylococcus aureus Surgical Site Infections: A Mutli-Center Matched Outcomes Study," Deverick J. Anderson et al., Public Library of Science Journal, PLoS One, December 15, 2009.

Richard J. Verdiramo is vice president and a board member of HandGiene Corp. Since graduating from Providence College in 1986, he has developed, served as a senior executive, board member and brought public, a range of companies specializing in Internet and new media marketing, healthcare and organic food products.