A data driven policy to minimise the tuberculosis testing cost among healthcare workers.

INTRODUCTION: The Centres for Disease Control and Prevention (CDC) mandates that healthcare employees at high-risk exposure to Tuberculosis (TB) undergo annual testing. Currently, two methods of TB testing are used: a two-step skin test (TST) or a whole-blood test (IGRA). Healthcare leadership's test selection must account for not only direct costs such as procedure and resources but also indirect costs, including employee workplace absence. METHODS: A mathematical model based on Upstate South Carolina's largest health system affecting over 18,000 employees on six campuses was developed to investigate the value loss perspective of these testing methods and assist in decision-making. A process flow map identified the varied direct and indirect costs for each test for four employee types, and 6 travel-to-testing-site times were calculated. RESULTS: The switching point between testing procedures that minimised total system costs was most influenced by employee salary compared to travel distance. Switching from the current hospital policy to an integrated TST/IGRA testing could reduce TB compliance costs by 28%. CONCLUSIONS: This study recommends an integrated approach as cost-effective for large health systems with multiple campuses while considering the direct and indirect costs. When accounting for 'inconvenience costs' (stress, etc.) associated with visits, IGRAs are recommended irrespective of employee salary.

The Influence of Traffic, Area Location, and Other Factors on Operating Room Microbial Load.

OBJECTIVE To determine how the movement of patients, equipment, materials, staff, and door openings within the operating room (OR) affect microbial loads at various locations within the OR. DESIGN Observation and sampling study. SETTING Academic health center, public hospital. METHODS We first analyzed 27 videotaped procedures to determine the areas in the OR with high and low numbers of people in transit. We then placed air samplers and settle plates in representative locations during 21 procedures in 4 different ORs during 2 different seasons of the year to measure microbial load in colony-forming units (CFU). The temperature and humidity, number of door openings, physical movement, and the number of people in the OR were measured for each procedure. Statistical analysis was conducted using hierarchical regression. RESULTS The microbial load was affected by the time of year that the samples were taken. Both microbial load measured by the air samplers and by settle plates in 1 area of the OR was correlated with the physical movement of people in the same area but not with the number of door openings and the number of people in the OR. CONCLUSIONS Movement in the OR is correlated with the microbial load. Establishing operational guidelines or developing OR layouts that focus on minimizing movement by incorporating desirable internal storage points and workstations can potentially reduce microbial load, thereby potentially reducing surgical site infection risk. Infect Control Hosp Epidemiol 2018;39:391-397.