| It is estimated that more than 1.7 million nosocomial infections and 98,000 deaths occur annually in the U.S. Nosocomial infections are associated with a longer length of stay (LOS), which is in-turn associated with higher costs and is a risk factor for additional infections. Infection prevention measures may allow a significant number of cases to be averted, although consensus has not been reached about the ultimate epidemiologic and economic value of prevention strategies. A multifaceted program of nosocomial infection prevention evaluating the surveillance test attributes, target population, and intervention implementation has potential to both improve patient outcomes and reduce healthcare costs. I developed models to evaluate and estimate the impact of these infection control interventions. First, testing adult hospital inpatients has the potential to prevent transmission of MRSA among patients. However, policy makers and hospital administrators must consider the diagnostic test used in a screening program. Increasing the number of anatomic sites tested with surveillance cultures does not appear to have as great an impact as decreasing turnaround time on the economic value of a MRSA testing strategy. Second, weekly surveillance of neonates in the neonatal intensive care unit (NICU) and isolation of those who test positive is a technique that hospitals could use to decrease the incidence on nosocomial infections, selecting neonates as a target population where MRSA infections have substantial morbidity. Hospitals with moderate to high adherence to isolation protocols have the potential to prevent adverse clinical outcomes and mortality among NICU populations. Third, routine dispensing of home-based preoperative chlorhexidine bathing kits has the potential to prevent post-operative surgical site infections (SSIs). Our model suggests that preoperative bathing would have substantial economic value throughout a wide range of intervention implementation scenarios: patient compliance levels, cloth efficacies, costs, and SSI-attributable LOS, supporting the distribution of chlorhexidine cloths preoperatively. The public health significance is that decision makers can use the models described here to benchmark the test characteristics, potential target populations, and intervention implementation strategies to utilize in local infection prevention programs. A comprehensive approach including the interventions modeled here may help move towards the elimination of healthcare acquired infections. |
