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The Cost–Benefit of Federal Investment in Preventing Clostridium difficile Infections through the Use of a Multifaceted Infection Control and Antimicrobial Stewardship Program

Published online by Cambridge University Press:  18 March 2015

Rachel B. Slayton ,
R. Douglas Scott II ,
James Baggs ,
Fernanda C. Lessa ,
L. Clifford McDonald  and
John A. Jernigan
Rachel B. Slayton*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
R. Douglas Scott II
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
James Baggs
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Fernanda C. Lessa
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
L. Clifford McDonald
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
John A. Jernigan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Address correspondence to Rachel B. Slayton, US Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-31, Atlanta, GA 30333 (via3@cdc.gov)
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Abstract

OBJECTIVE

To determine the potential epidemiologic and economic value of the implementation of a multifaceted Clostridium difficile infection (CDI) control program at US acute care hospitals

DESIGN

Markov model with a 5-year time horizon

PARTICIPANTS

Patients whose data were used in our simulations were limited to hospitalized Medicare beneficiaries ≥65 years old.

BACKGROUND

CDI is an important public health problem with substantial associated morbidity, mortality, and cost. Multifaceted national prevention efforts in the United Kingdom, including antimicrobial stewardship, patient isolation, hand hygiene, environmental cleaning and disinfection, and audit, resulted in a 59% reduction in CDI cases reported from 2008 to 2012.

METHODS

Our analysis was conducted from the federal perspective. The intervention we modeled included the following components: antimicrobial stewardship utilizing the Antimicrobial Use and Resistance module of the National Healthcare Safety Network (NHSN), use of contact precautions, and enhanced environmental cleaning. We parameterized our model using data from CDC surveillance systems, the AHRQ Healthcare Cost and Utilization Project, and literature reviews. To address uncertainty in our parameter estimates, we conducted sensitivity analyses for intervention effectiveness and cost, expenditures by other federal partners, and discount rate. Each simulation represented a cohort of 1,000 hospitalized patients over 1,000 trials.

RESULTS

In our base case scenario with 50% intervention effectiveness, we estimated that 509,000 CDI cases and 82,000 CDI-attributable deaths would be prevented over a 5-year time horizon. Nationally, the cost savings across all hospitalizations would be $2.5 billion (95% credible interval: $1.2 billion to $4.0 billion).

CONCLUSIONS

The potential benefits of a multifaceted national CDI prevention program are sizeable from the federal perspective.

Infect Control Hosp Epidemiol 2015;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 6 , June 2015 , pp. 681 - 687
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

1. Lessa, FC, Gould, CV, McDonald, LC. Current status of Clostridium difficile infection epidemiology. Clin Infect Dis 2012;55:S65–S70.Google Scholar
2. Lucado, J, Gould, C, Elixhauser, A. Clostridium difficile infections (CDI) in hospital stays, 2009: Statistical Brief #124 Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: Agency for Health Care Policy and Research, 2006.Google Scholar
3. Dubberke, ER, Olsen, MA. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis 2012;55(Suppl 2):S88–S92.Google Scholar
4. McGlone, SM, Bailey, RR, Zimmer, SM, et al. The economic burden of Clostridium difficile . Clin Microbiol Infect 2012;18:282–289.Google Scholar
5. Bradley, T, Topoleski, J. An overview of the medicare program. Congressional Budget office website. http://www.cbo.gov/publication/44587. Published 2013. Accessed May 2014.Google Scholar
6. Clostridium difficile infection: how to deal with the problem. Public Health England website. http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1232006607827. Published 2008. Accessed October 23, 2013.Google Scholar
7. Summary points on Clostridium difficile Infection (CDI). Public Health England website. http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1278944283388. Published 2013. Accessed October 9, 2013.Google Scholar
8. Operational guidance for HPUs on HCAI in health/social care. Public Health England website. http://www.hpa.org.uk/hpr/archives/2012/hpr2912.pdf. Published 2012. Accessed October 9, 2013.Google Scholar
9. Ashiru-Oredope, D, Sharland, M, Charani, E, McNulty, C, Cooke, J, Group AAS. Improving the quality of antibiotic prescribing in the NHS by developing a new antimicrobial stewardship programme: start smart—then focus. J Antimicrob Chemotherapy 2012;67:i51–i63.CrossRefGoogle ScholarPubMed
10. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.Google Scholar
11. Antimicrobial Use and Resistance (AUR) module. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/11pscAURcurrent.pdf. Published 2013. Accessed September 25, 2013.Google Scholar
12. Dubberke, ER, Butler, AM, Nyazee, HA, et al. The impact of ICD-9-CM code rank order on the estimated prevalence of Clostridium difficile infections. Clin Infect Dis 2011;53:20–25.Google Scholar
13. Baggs, J, Yousey-Hindes, K, Dodds-Ashley, E, et al. Identification of “high” risk population for future Clostridium difficile infection (CDI) paper presented at IDWeek2013; October 2–6, 2013, San Francisco, California.Google Scholar
14. Annual survey database. American Hospital Association website. http://www.ahadata.com/ahadata/html/AHASurvey.html. Published 2012. Accessed September 25, 2013.Google Scholar
15. Emerging infections program: healthcare associated infections project. Centers for Disease Control and Prevention website. http://www.cdc.gov/hai/eip/clostridium-difficile.html. Published 2012. Accessed September 30, 2013.Google Scholar
16. CMS Medicare Provider Analysis and Review (MEDPAR) file, 2008 and 2009. Centers for Medicare & Medicaid Services website. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareFeeforSvcPartsAB/MEDPAR.html. Published 2011. Accessed June 2013.Google Scholar
17. Yi, SH, Baggs, J, Gould, CV, Scott, RD 2nd, Jernigan, JA. Medicare reimbursement attributable to catheter-associated urinary tract infection in the inpatient setting: a retrospective cohort analysis. Med Care 2014;52:469–478.Google Scholar
18. Malpiedi, PJ, Peterson, KD, Soe, MM. 2011 National and state healthcare-associated infection standardization infection ratio report. Atlanta, GA: Centers for Disease Control and Prevention, 2013.Google Scholar
19. Chronic Condition Data Warehouse website. https://www.ccwdata.org/web/guest/home. Published 2013. Accessed September 25, 2013.Google Scholar
20. Archived Consumer Price Index Detailed Report Information. Bureau of Labor Statistics website. http://www.bls.gov/cpi/cpi_dr.htm#2012. Published 2013. Accessed May 2014.Google Scholar
21. Palmer, HR, Weston, J, Gentry, L, et al. Improving patient care through implementation of an antimicrobial stewardship program. AJHP 2011;68:2170–2174.Google Scholar
22. Beardsley, JR, Williamson, JC, Johnson, JW, Luther, VP, Wrenn, RH, Ohl, CC. Show me the money: long-term financial impact of an antimicrobial stewardship program. Infect Control Hosp Epidemiol 2012;33:398–400.Google Scholar
23. Standiford, HC, Chan, S, Tripoli, M, Weekes, E, Forrest, GN. Antimicrobial stewardship at a large tertiary care academic medical center: cost analysis before, during, and after a 7-year program. Infect Control Hosp Epidemiol 2012;33:338–345.Google Scholar
24. Sick, AC, Lehmann, CU, Tamma, PD, Lee, CK, Agwu, AL. Sustained savings from a longitudinal cost analysis of an internet-based preapproval antimicrobial stewardship program. Infect Control Hosp Epidemiol 2013;34:573–580.CrossRefGoogle ScholarPubMed
25. Owens, RC Jr., Donskey, CJ, Gaynes, RP, Loo, VG, Muto, CA. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis 2008;46(Suppl 1):S19–S31.Google Scholar
26. Davey, P, Brown, E, Charani, E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Revs 2013;4:CD003543.Google Scholar
27. Valiquette, L, Cossette, B, Garant, MP, Diab, H, Pepin, J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis 2007;45:S112–S121.Google Scholar
28. Society for Healthcare Epidemiology of America; Infectious Diseases Society of America; Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 2012;33:322–327.Google Scholar
29. Fact sheets: CMS proposals to improve quality of care during hospital inpatient stays. Centers for Medicare and Medicaid Services website. http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-Items/2013-04-262.html. Published 2013. Accessed October 17, 2013.Google Scholar
30. Overview of the Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) website. www.hcup-us.ahrq.gov/nisoverview.jsp. Published 2013. Accessed September 25, 3013.Google Scholar
31. Sievert, DM, Ricks, P, Edwards, JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol 2013;34:1–14.Google Scholar
32. Jernigan, JA, Clemence, MA, Stott, GA, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686–696.Google Scholar
33. Puzniak, LA, Gillespie, KN, Leet, T, Kollef, M, Mundy, LM. A cost-benefit analysis of gown use in controlling vancomycin-resistant Enterococcus transmission: is it worth the price? Infect Control Hosp Epidemiol 2004;25:418–424.Google Scholar
34. May 2011 National Occupational Employment and Wage Estimates United States. Bureau of Labor Statistics website. www.bls.gov/oes/current/oes_nat.htm. Published 2013. Accessed September 25, 2013.Google Scholar
35. Clean Quick Liquid Quaternary Sanitizer. Janitor's World website. www.janitors-world.com/clquliqusa.html. Published 2013. Accessed October 28, 2013.Google Scholar
36. Dispatch Hospital Cleaner Disinfectants with Bleach. Staples website. http://www.staples.com/Dispatch-Hospital-Cleaner-Disinfectants-with-Bleach-128-oz-Refill-4-Pack/product_109677. Published 2013. Accessed October 28, 2013.Google Scholar