Major ArticlesA systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990-2000*
Section snippets
Economic evaluations
Economic evaluations of infection prevention and control policies and practices are only meaningful if the new intervention is compared with a realistic comparison policy and practice. Similarly, costs can only be attributable to an NI if there is an adequate control group of similar patients who did not acquire an NI. A simple cost analysis is performed by measuring the costs of a disease or intervention without a comparison group. Although the information from a simple cost analysis is useful
Literature search
To understand the state of the published literature regarding economic evidence of NIs and infection prevention and control practices, we conducted a systematic review of the literature. To find the published analyses, we searched MEDLINE and HealthSTAR with the medical subject headings, or text keywords, “nosocomial infections,” “infection control,” or “hospital acquired infections” cross-referenced with “costs,” “cost analysis,” “economics,” or “cost-effectiveness analysis.” In addition,
The audit
We developed our audit form on the basis of the Harvard Center for Risk Analysis audit form (www.hsph.harvard.edu/organizations/hcra/cuadatabase/intro.html ). The following descriptive data were collected from each analysis: geographic region of study, publishing journal, sponsorship or funding source, patient population or setting, type of NI analyzed, and use of Centers for Disease Control and Prevention definitions for NIs. The following analytic data were collected from each analysis: type
Results
A final set of 55 articles was judged ultimately to contain original cost estimates and became part of our database. Table 2 describes the descriptive and analytic characteristics of the studies.Descriptive characteristics N % Geographical region of study United States/Canada 31 56.4 Europe 16 29.1 Australia 4 7.3 Asia 2 3.6 South America 2 3.6 Journal Infection control 23 41.8 Infection disease/epidemiology 12 21.8 Other clinical specialty 20 36.4 Source of funding Government 7 12.7 Industry 6 10.9
Discussion
We found the published economic evidence on NI and infection control and prevention to be lacking in rigor. For example, there were a variety of methods used, with only 1 study meeting reference case recommendations. In addition and more troubling, many of the studies were simple cost analyses that did not include a comparison group, which make the results difficult to interpret. Many other audits of economic evidence in health care have also found the evidence to be lacking in terms of
References (82)
- et al.
Cost-utility analyses of clinical preventive services: published ratios, 1976-1997
Am J Preventive Med
(2000) - et al.
Randomized trial comparing packed red cell blood transfusion with and without leukocyte depletion for gastrointestinal surgery
Am J Surg
(1998) - et al.
Application of cost-effectiveness methodology to the consideration of needlestick-prevention technology
Am J Infect Control
(1994) - et al.
Economic effects of nosocomial infections in cardiac surgery
J Hosp Infect
(1990) - et al.
The cost of infection in surgical patients: a case-control study
J Hosp Infect
(1993) - et al.
Economic implications of an early postoperative enteral feeding protocol
J Am Diet Assoc
(1999) - et al.
Impact of a dedicated intravenous therapy team on nosocomial bloodstream infection rates
Am J Infect Control
(1998) - et al.
Counting the cost: hospital versus home central venous catheter survival
J Hosp Infect
(1997) - et al.
Financial burden of hospital-acquired Clostridium difficile infection
J Hosp Infect
(1996) - et al.
Cost analysis and clinical impact of weekly ventilator circuit changes in patients in intensive care unit
Am J Infect Control
(1997)
Switch therapy in community-acquired pneumonia
Diagnostic Microbiol Infect Dis
Cefoperazone versus ceftriaxone monotherapy of nosocomial pneumonia
Diagn Microbiol Infect Dis
Infection control programmes-are they cost-effective?
J Hosp Infect
Chickenpox outbreak among the staff of a large, urban adult hospital: costs of monitoring and control
Am J Infect Control
Efficacy and cost-effectiveness of a needleless intravenous access system
Am J Infect Control
Universal Precautions: costs for protective equipment
Am J Infect Control
Direct costs associated with a nosocomial outbreak of Salmonella infection: an ounce of prevention is worth a pound of cure
Am J Infect Control
Cost-utility in practice: a policy maker's guide to the state of the art
Health Policy
Current methods of the US Preventive Services Task Force. A review of the process
Am J Prev Med
The art and science of incorporating cost effectiveness into evidence-based recommendations for clinical preventive services
Am J Prev Med
Public health focus: surveillance, prevention, and control of nosocomial infections
MMWR Morb Mortal Wkly Rep
System report, data summary from January 1992-April 2000
Am J Infect Control
Healthy people 2010/US Dept of Health and Human Services
Experts see need to control antibiotics and hospital infections
New York Times
The nationwide nosocomial infection rate. A new need for vital statistics
Am J Epidemiol
Analyzing economic outcomes in advanced practice nursing
Estimating costs in the economic evaluation of medical technologies
Int J Technol Assess Health Care
Cost-effectiveness in health and medicine
Measuring costs in cost-utility analyses. Variations in the literature
Int J Technol Assess in Health Care
Methods for the economic evaluation of health care programmes
Australian guidelines
Guidelines for economic evaluation of pharmaceuticals
Guidelines for formulary submissions
The role of cost-effectiveness analysis in health and medicine. Panel on Cost-Effectiveness in Health and Medicine
JAMA
Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine
JAMA
Cost-effectiveness of hepatitis A vaccination in healthcare workers
Infect Control Hosp Epidemiol
Optimal interval for triple-lumen catheter changes: a decision analysis
Med Decision Making
Automated entry of hospital infection surveillance data
Infect Control Hosp Epidemiol
Control of nosocomial infections in an intensive care unit in Guatemala City
Clin Infect Dis
Medical and economic benefit of a comprehensive infection control program that includes routine determination of microbial clonality
Am J Clin Pathol
Cost improvements through the establishment of prudent infection control practices in a Brazilian general hospital, 1986-1989
Infect Control Hosp Epidemiol
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Reprint requests: Patricia W. Stone, RN, PhD, Columbia University, School of Nursing, 630 W 168th St, Mailbox 6, New York, NY 10032.