The Socio-Economic Burden of Hospital
Acquired Infection
Excerpted from a report by the Public
Health Laboratory Service, U.K.
At any one time approximately one in 10
patients in acute care hospitals have a hospital-acquired infection (HAI). At
the same time, an unquantified number of patients, discharged from hospital
into a long-term care facility or the community, have an infection related to
their recent hospital admission. These infections impose a burden on the
secondary, tertiary and primary healthcare sectors, community care services,
the patients themselves and those who care for them. These burdens may be both
financial and non-financial.
Studies that have estimated the cost of HAI
generally focus on the burden to the hospital sector. Little is known about the
costs incurred by other sectors of public health services as listed above, the
individual patients, their family and friends. These costs become increasingly
relevant as the length of hospital stay becomes shorter and patients are
discharged home at an earlier point in their recovery. The aim of this research
was to provide a more comprehensive assessment of the nature, distribution and
magnitude of the costs resulting from HAIs.
RESEARCH METHODS
Adult patients with a minimum in-patient
stay of 30 hours were recruited from the general wards of a district general
hospital over a 13-month period.
Information on daily resource use was
recorded for each patient for the duration of their hospital stay. Patients who
presented with signs and symptoms of infection which met the definitions of
infection used in this study, and a sample of patients who did not, were
followed up post-discharge using a structured questionnaire. This questionnaire
provided information on possible surgical wound, chest and urinary tract
infections experienced after discharge from hospital; care received from health
and community care services, family and friends; personal expenditure on items
such as drugs and dressings; time of return to normal activities and, if
applicable, employment; and information on the patient’s health status
following discharge from hospital. Information about care received
post-discharge was also obtained from the patient’s healthcare records.
Three thousand, nine hundred and eighty
(3980) adult patients were recruited in to the study from the medical,
surgical, orthopaedic, urology, gynaecology, ear, nose and throat (ENT), and
elderly care. Two hundred and fifteen (215) had an infection identified during
the in-patient phase; a total of 1449 patients were selected for follow-up into
the community. Of those selected for follow-up, 41 died either before the
questionnaire was sent at four weeks post-discharge, or between the
distribution of the first and second questionnaires at eight weeks post-discharge.
All 41 patients were excluded from the response rate, although four of these
patients had an HAI identified during the in-patient phase.
During the in-patient phase, 7.8 per cent
of patients were identified as having acquired
one or more HAIs. Nineteen (19) per cent of those patients who returned
the questionnaire and who did not have an HAI identified during the in-patient
phase, and 30 per cent of patients who did have an HAI identified during the
in-patient phase reported symptoms and treatment that met the criteria for a
post-discharge urinary tract, chest and/or surgical site infection during this
study.
Impact of
HAI on length of hospital stay and costs
Patients who presented with one or more
HAIs during their in-patient stay were found to have been hospitalized for a
period 2.9 times longer than those for uninfected patients, an additional 14
days. Hospital overheads, capital charges and the cost of management time
accounted for 33 per cent of the additional costs incurred, while nursing care accounted
for 42 per cent, medical care six per cent, paramedics and specialist nurses
four per cent, antimicrobials two per cent, other drugs three per cent,
microbiology tests one per cent and other tests and investigations three per
cent.
Impact of
HAI on the healthcare sector post-discharge
Patients who had an HAI identified during
the in-patient phase and/or infection identified post-discharge had, on
average, greater contact with their family physician, visited the hospital more
frequently for outpatient appointments, and received more visits from homecare
nurses as compared with uninfected patients. These infected patients therefore
imposed an additional economic burden on such services. Patients who had an HAI
identified during the in-patient phase and/or identified post-discharge, on
average, had a greater impact on community nursing costs compared with
uninfected patients. Patients who presented with an HAI as an in-patient and
subsequent infection post-discharge had the greatest impact on community nursing
costs.
Impact of
HAI on costs incurred by patients
The mean personal expenditure on items such
as drugs and dressings was found to be between 1.7 and 3.2 times greater than
the uninfected group. Increases were found to be greatest for patients who
presented with an HAI as an in-patient and also had an HAI identified
post-discharge.
Impact of HAI on the number of days from
admission to return to normal daily activities.
The mean number of days from admission to
resuming normal daily activities was greater for patients in the infected
groups by a multiple of 1.2 to 1.5, or between six and 13 days.
Impact of HAI on the number of days
employed patients were away from paid employment.
The mean number and value of days from
admission to return to paid employment was greater for patients who had
acquired an HAI. Those patients who had presented with an HAI as an in-patient
required 1.3 times longer than uninfected patients, an extra six days. Those
who were found to have an HAI post-discharge required 1.2 times longer, an
extra five days.
Impact of HAI on the number of days
informal caregivers spent caring for patients and their dependents
The mean number of days of care provided by
family, friends and other “informal caregivers” for patients infected with an
HAI was 1.4 to two times greater than that of uninfected.
Impact of
HAI on health status
The response given to the general health
status questionnaire, administered four weeks post-discharge, provided
information on eight dimensions of health. Two summary measures relating to
physical and mental well-being were derived from these data. Patients with an
HAI, on average, obtained lower scores for these two measures than patients who
did not acquire an infection, indicating a poorer outcome as determined by
these health measures. Patients who presented with an HAI as in in-patient and
met the study criteria for a post-discharge infection, on average, reported the
lowest health status.
Impact of
HAI on in-patient mortality
The in-patient death rate was found to be
considerably higher in patients with an HAI which presented during the hospital
stay – 13 per cent of patients with an HAI died compared with two per cent of
patients who did not present with an HAI in hospital. After adjustment for the
effects of age, sex, diagnosis, number of co-morbidities, admission specialty
and admission type, patients with an HAI were found to be 7.1 times more likely
to die in hospital than uninfected patients.
The
benefits of prevention
This study was not directly concerned with
estimating the benefits of prevention. However, the estimates presented provide
important information on the value of resources that might be released for
alternative use if a proportion of infections are prevented. These may be
viewed as the gross benefits of prevention. Net benefits will depend on the
cost and effectiveness of prevention activities.
The results of this study provide a
detailed account of the socio-economic burden imposed by HAIs occurring in
adult patients admitted to selected specialties. It represents the first
comprehensive attempt to estimate these costs. The results provide valuable
information that might be used at national and local levels to inform the
management of HAI and, when used alongside effectiveness studies of infection
prevention and control measures, will facilitate the development of effective
policies to control hospital acquired infection.
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Reprinted from the February 2007 Solutions Newsletter from Virox Technologies
Inc.
