A systematic review and meta-analysis of the direct epidemiological and economic effects of seasonal influenza vaccination on healthcare workers.

BACKGROUND: Influenza vaccination is a commonly used intervention to prevent influenza infection in healthcare workers (HCWs) and onward transmission to other staff and patients. We undertook a systematic review to synthesize the latest evidence of the direct epidemiological and economic effectiveness of seasonal influenza vaccination among HCW. METHODS: We conducted a systematic search of MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials from 1980 through January 2018. All studies comparing vaccinated and non-vaccinated (i.e. placebo or non-intervention) groups of HCWs were included. Research articles that focused on only patient-related outcomes or monovalent A(H1N1)pdm09 vaccines were excluded. Two reviewers independently selected articles and extracted data. Pooled-analyses were conducted on morbidity outcomes including laboratory-confirmed influenza, influenza-like illnesses (ILI), and absenteeism. Economic studies were summarized for the characteristics of methods and findings. RESULTS: Thirteen articles met eligibility criteria: three articles were randomized controlled studies and ten were cohort studies. Pooled results showed a significant effect on laboratory-confirmed influenza incidence but not ILI. While the overall incidence of absenteeism was not changed by vaccine, ILI absenteeism was significantly reduced. The duration of absenteeism was also shortened by vaccination. All published economic evaluations consistently found that the immunization of HCW was cost saving based on crude estimates of avoided absenteeism by vaccination. No studies, however, comprehensively evaluated both health outcomes and costs of vaccination programs to examine cost-effectiveness. DISCUSSION: Our findings reinforced the influenza vaccine effects in reducing infection incidence and length of absenteeism. A better understanding of the incidence of absenteeism and comprehensive economic program evaluations are required to ensure the best possible management of ill HCWs and the investment in HCW immunization in increasingly constrained financial environments. These steps are fundamental to establish sustainability and cost-effectiveness of vaccination programs and underpin HCW immunization policy.

Safeguarding quality: building the business case to prevent nursing-sensitive hospital-acquired conditions.

In the wake of recent changes by the Centers for Medicare and Medicaid Services to the Inpatient Prospective Payment System and a profoundly weakening economic climate, concern about preventable, hospital-acquired conditions (HACs) has captured the attention of healthcare executives nationwide. Despite the rapidly growing concern about reimbursement at risk, however, data suggest that the greatest financial opportunity for all HACs is to prevent them from happening in the first place. Based on analysis conducted by the Nursing Executive Center's Data and Analytics Group, the authors quantify reimbursement at risk due to HACs and calculate the cost-savings opportunity, building the business case for investment to prevent nursing-sensitive HACs.

Impact of Bordetella pertussis exposures on a Massachusetts tertiary care medical system.

OBJECTIVE: To assess the impact of outbreaks of Bordetella pertussis infection on a tertiary care medical system. DESIGN: Retrospective study. SETTING: Academic tertiary care medical center and affiliated ambulatory care settings. SUBJECTS: All patients and healthcare workers (HCWs) who were in close contact with patients with laboratory-confirmed cases of B. pertussis infection from October 1, 2003, through September 30, 2004. INTERVENTION: Direct and indirect medical center costs were determined, including low and high estimates of time expended in the evaluation and management of exposed patients and HCWs during outbreak investigations of laboratory-confirmed cases of B. pertussis infection. RESULTS: During this period, 20 primary and 3 secondary laboratory-confirmed cases of B. pertussis infection occurred, with 2 primary pertussis cases and 1 secondary case occurring in HCWs. Outbreak investigations prompted screening of 353 medical center employees. Probable or definitive exposure was identified for 296 HCWs, and 287 subsequently received treatment or prophylaxis for B. pertussis infection. Direct medical center costs for treatment and prophylaxis were $13,416 and costs for personnel time were $19,500-$31,190. Indirect medical center costs for time lost from work were $51,300-$52,300. The total cost of these investigations was estimated to be $85,066-$98,456. CONCLUSIONS: Frequent B. pertussis exposures had a major impact on our facility. Given the impact of exposures on healthcare institutions, routine vaccination for HCWs may be beneficial.

[HCV infection from the viewpoint of medical law]. / A hepatitis egészségügyi jogi megközelítése.

More than 200 million people worldwide and 0.7 percent of the population in Hungary are infected with hepatitis C virus (HCV). The consequent chronic viral hepatitis and its complications as well as the big population affected make HCV-infection an important medical issue. In addition to that the infection which is transmitted nowadays mainly by intravenous drug use and use of body jewelry, tattooing and sexual in some cases, and by blood transfusion in the past, raises several questions related to law as well. The authors give a short overview of the legal concerns of HCV infection highlighting some concrete juridical procedures in the present paper.

Impact of an outbreak of norovirus infection on hospital resources.

OBJECTIVE: To describe a nosocomial norovirus outbreak, its management, and its financial impact on hospital resources. DESIGN: A matched case-control study and microbiological investigation. METHODS: We compared 16 patients with norovirus infection with control-patients matched by age, gender, disease category, and length of stay. Bed occupancy-days during the peak incidence period of the outbreak were compared with the corresponding periods in 2001 and 2002. Expenses due to increased workload were calculated based on a measuring system that records time spent for nursing care per patient per day. RESULTS: The attack rates were 13.9% among patients and 29.5% among healthcare workers. The median number of occupied beds was significantly lower due to bed closure during the peak incidence in 2003 (29) compared with the median number of occupied beds in 2001 and 2002 combined (42.5). Based on this difference and a daily charge of 562.50 dollars per patient, we calculated a revenue loss of 37,968 dollars. Additional expenses totaled 10,300 dollars for increased nursing care. Extra costs for microbiological diagnosis totaled 2707 dollars. Lost productivity costs due to healthcare workers on sick leave totaled 12,807 dollars. The expenses for work by the infection control team totaled 1408 dollars. The financial impact of this outbreak on hospital resources comprising loss of revenue and extra costs for microbiological diagnosis but without lost productivity costs, increased nursing care, and expenses for the infection control team totaled 40,675 dollars. CONCLUSIONS: Nosocomial norovirus outbreaks result in significant loss of revenue and increased use of resources. Bed closures had a greater impact on hospital resources than increased need for nursing care

Health and economic consequences of an outbreak of pertussis among healthcare workers in a hospital in France.

BACKGROUND: Bordetella pertussis is highly contagious, and because immunity wanes after vaccination, it continues to be a cause of cough among adults. OBJECTIVE: To describe the healthcare services used and productivity losses accrued by healthcare workers (HCWs) missing work due to pertussis. METHODS: After 3 pertussis cases were confirmed among HCWs, all hospital employees and patients with a cough were screened between November 2000 and March 2001. Each potential case underwent diagnostic tests and received antibiotics (spiramycin or azithromycin) when appropriate. Symptomatic employees were not allowed to return to work until they received an antibiotic for at least 5 days. Services used (physician visits and calls, antibiotics, diagnostic tests, hospitalization, and treatment provided to their contacts) were combined with cost estimates (in 2002 euros) for these services in France. RESULTS: Ninety-one potential cases were identified (77 HCWs, 12 patients, and 2 family members). Of them, 89% received antibiotics and 22% had at least one contact who was also treated. Approximately half (55%) of the HCWs who were cases missed 5 days of work. Four patients were admitted to the hospital as a result of the infection. The average medical cost was 297 euros per potential case: diagnostic tests accounted for 32% and hospitalization for 31%. Total cost (medical and productivity) was 46,661 euros for 91 cases, 42% from productivity losses. An investigation to identify these potential cases also accrued additional costs. CONCLUSION: Serious adverse health and economic consequences arose from transmission of pertussis among HCWs, their families, and patients.

HIV screening of surgeons and dentists: a cost-effectiveness analysis.

OBJECTIVE: To assess the cost-effectiveness of human immunodeficiency virus (HIV) screening strategies of surgeons and dentists. DESIGN: We constructed a model to project costs and HIV transmissions prevented over 15 years for four screening scenarios: 1) one-time voluntary screening, 2) one-time mandatory screening, 3) annual voluntary screening, and 4) annual mandatory screening. One-time screening occurs only in the first year of the program; annual screening occurs once each year. Under mandatory screening, all practitioners are tested and risks of practitioner-to-patient transmission are eliminated for all practitioners testing positive. Voluntary screening assumes 90% of HIV-positive and 50% of HIV-negative practitioners are tested, and risks of transmission in the clinical setting are eliminated for 90% of HIV-positive surgeons and dentists. All costs and benefits are discounted at 5% per annum over 15 years. RESULTS: Using "best-case" scenario assumptions, we find for surgeons that a one-time voluntary screening program would be most cost-effective, at $899,336 for every HIV transmission prevented. For dentists, the one-time voluntary program also is the most cost-effective, at $139,571 per transmission prevented. Annual mandatory programs were least cost-effective for both surgeons and dentists, at $63.3 million and $2.2 million per transmission prevented, respectively. CONCLUSIONS: HIV screening of surgeons and dentists ranks among the more expensive medical lifesaving programs, even using liberal assumptions about program effectiveness. Frequency of screening and whether testing is mandatory or voluntary dramatically affect cost per transmission prevented; these features should be considered carefully in designing specific HIV screening programs.

The cost-effectiveness of HIV testing of physicians and dentists in the United States.

OBJECTIVE: To evaluate the cost-effectiveness of alternative policies for human immunodeficiency testing (HIV) testing of physicians and dentists. METHODS: Decision analysis and cost-effectiveness analysis from a societal perspective were used. Data were derived from extensive literature review and consultation with experts. We conducted sensitivity analyses and also performed a cost-benefit analysis. ANALYSES: We analyzed policies for mandatory or voluntary testing of all physicians, surgeons, and dentists; for those testing positive, we analyzed mandatory or voluntary exclusion from practice, restriction from performance of invasive procedures, or requirements to inform patients of serostatus. MAIN OUTCOME MEASURE: Cost per patient infection averted. RESULTS: Although one-time mandatory testing of surgeons and dentists with mandatory restriction of those found to be HIV-positive is more cost-effective than other policies, the cost-effectiveness varies tremendously under different scenarios. Results were highly sensitive to several data inputs, especially HIV seroprevalence of surgeons and dentists and transmission risk. For example, under a medium seroprevalence and transmission risk scenario, mandatory testing of all surgeons might avert 25 infections at a total cost of $27.9 million or $1,115,000 per infection averted and an incremental cost of $291,000 compared with current testing; however, the incremental cost-effectiveness per patient infection averted ranges from $29,807,000 under a low-risk scenario to a savings of $81,000 under a high-risk scenario. CONCLUSION: Our analysis neither justifies nor precludes a mandatory testing policy. Further research on the key data inputs is needed. Given the ethical, social, and public health implications, mandatory testing policies should not be implemented without greater certainty as to their cost-effectiveness.

Cost-effectiveness analysis of screening health care workers for HIV.

BACKGROUND: Because of the public's concern regarding the possibility of human immunodeficiency virus (HIV) transmission from health care worker to patient, this study evaluated the cost-effectiveness of screening health care workers for HIV. METHODS: The study examined a screening protocol that would include a sequence of antibody tests (enzyme-linked immunosorbent assay and the Western blot) and culture for HIV. The incremental cost-effectiveness of applying this protocol as opposed to the status quo for the prevention of transmission of HIV from health care worker to patient was evaluated. Sensitivity analysis was performed on appropriate variables. The incremental cost-effectiveness ratio was then compared with that of other interventions. RESULTS: The expected annual cost of screening to a large hospital was found to be $244,382 to prevent 0.02663 transmissions. The incremental cost-effectiveness ratio was $9,177,615 per transmission prevented. Sensitivity analysis revealed that the incremental cost-effectiveness ratio is relatively insensitive to the variability in the performance characteristics of the individual tests but highly sensitive to variance in HIV prevalence, estimated risk of transmission, and the number of exposure-prone procedures performed annually. Cost-effectiveness ratios ranged from $917,762 to $91,776,156 per transmission prevented. CONCLUSIONS: Screening health care workers for prevention of potential HIV transmission to patients is an expensive use of health care resources.