A model for calculating costs of hospital-acquired infections: an Italian experience.

PURPOSE: Many approaches on the economic aspect of hospital acquired infections (HAIs) have two major limitations: first, the lack of distinction between resources attributable to the management of HAI and resources absorbed by the main clinical problem for which the patient was hospitalized, and second, the lack of an adequate method for calculating the relative costs. These assume that the resources used by HAI can be determined by measuring the extra days of length of days (LOS) of infected patients versus non-infected patients and attribute to extra-LOS a value to the mean total cost. The aim of the article is to test a cost-modelling method that could overcome these limitations by applying the appropriateness evaluation protocol to the medical charts of patients with hospital-acquired symptomatic urinary tract infection (UTI) or sepsis, and by using cost-centre accounting. DESIGN/METHODOLOGY/APPROACH: The paper explains and tests a model for calculating costs of HAIs. FINDINGS: The data analysis showed that it is not always true that infections protract LOS: five out of 25 sepsis cases have extra-LOS and eight out of 25 UTI cases have extra-LOS, while the cases of sepsis that arose in surgery ward and intensive care units and urinary tract infections in ICU are without prolongation of LOS. The data analysis also showed that, using the mean total cost, the three cases of sepsis in the general surgery and the six in the ICU did not incur costs, nor did the two cases of UTI in ICU, so that they appear to be infections at zero cost. Moreover, the weight of the cost for the bed, or for the diagnostic services, or for the pharmacological treatment, varied widely depending on the site of the HAI and the ward where the patient was hospitalized. ORIGINALITY/VALUE: The method can be applied in any hospital.

[A method to determine hospital costs associated with nosocomial infections]. / Una metodologia di determinazione dei costi delle infezioni nosocomiali.

Several studies on the economic aspect of HAI have two major limitations: (1) the lack of distinction between resources attributable to the management of HAI and resources absorbed by the main clinical problem for which the patient was hospitalized, and (2) the lack of an adequate method for calculating the relative costs. The aim of the study was to test a cost modelling method that could overcome these limitations by applying Appropriateness Evaluation Protocol (AEP) to the medical charts and by using cost-centre accounting. Two types of HAI were chosen: UTI and sepsis. The data analysis showed that using this system the extra-length of stay can be cut down to nil in General Surgery and Intensive Care for sepsis and in Intensive Care for the UTI. Moreover it becomes clear that the weight of the cost for the bed, or for the diagnostic services, or again for the pharmacological treatment, varied widely depending on the site of the HAI and the ward where the patient was hospitalized. Comparing cost of HAI calculated on the basis of the main total cost per day of hospitalization attributable to the HAI we have finally seen that some cases do not produce any costs, whereas others account costs due not to HAI (operating room) or more expensive costs than the really HAl-treatment-attributable ones, as sepsis in Urology ward (Euro 988.18 versus Euro 747.41) or UTI in General Surgery ward (Euro 603.77 versus Euro 479.30), in Neurology (Euro 4242.91 versus Euro 2278.48) and in Orthopedics (Euro 2328.99 versus Euro 1332.81).

Preventability of percutaneous injuries in healthcare workers: a year-long survey in Italy.

The aim of the study was to examine the preventability of percutaneous injuries either through the adoption of correct behaviour or by the use of needles with safety features. We analysed the report forms of occupational needlestick or sharps injuries in a sample of healthcare workers exposed to the risk of percutaneous injuries in the period between 1 June 2000 and 31 May 2001; the forms were returned to the regional SIROH (Italian Study on Occupational Exposure to HIV) centre in which all hospitals of the Piemonte region (Italy) participate. Percutaneous injuries caused by needles (injection, phlebotomy, infusion), suture needles and scalpels were analysed; three samples were extracted according to the type of device that caused the injury. In the sample of 439 needlestick-related percutaneous injuries, 74% were caused by incorrect health worker behaviour and 26% were unpreventable, seventy-nine percent of accidents caused by incorrect behaviour and 24% of accidents could have been prevented by using needles with safety features. In the sample of 221 suture needle and 114 scalpel injuries, incorrect health worker behaviour was identified in 26.2% and 14%, respectively, and unpreventable causes in 73.8% and 50.9%, respectively. A high rate of percutaneous injuries, especially those involving needles for injection, phlebotomy, infusion, and scalpels, could be prevented by adopting safe work behaviour practices and using personal protection equipment. The introduction of devices with safety features could lead to a significant reduction in the number of injuries from needles.