Dollars and nonsense: ICPs battle bugs, rituals

Outbreaks and pillow talk yield big $avings

Whether it is ending an outbreak of drug-resistant bacteria or cutting an expensive ritual from health care policy, infection control professionals are increasingly aware of proving the bottom line value of their programs. Two cases in point were presented recently in Seattle at the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC).

"Lessons learned from this outbreak include something everyone in this room already knows," said Alexis Raimondi, RN, an ICP at Beth Israel Medical Center in New York City. "It costs less to prevent hospital-associated infections than the actual costs of nosocomial infections to the hospital, patients, and society."¹

Raimondi described a troublesome and expensive 1999 outbreak of multidrug-resistant Acineto-bacter that was fueled by infection control breaches that included lax hand washing, inappropriate glove use, and mixing clean and dirty supplies. Exacerbating the problem were persistent environmental reservoirs in the hospital. "This strain was isolated after terminal cleaning of patient rooms," she told APIC attendees.

The outbreak epicenter was a 35-bed medical unit for geriatric patients, and those under long-term ventilation. Rigid infection control measures, included dedicated staff assignments, were instituted. "[Patients] were placed in strict isolation and cohorted," she said. "All staff, including physicians, nurses, respiratory, and physical therapists were required to gown, glove, and mask."

In addition, supplies and equipment were
dedicated to individual patients. Emphasis was placed on removing barriers to hand washing and adding new sinks. Because environmental cultures taken after rooms had been terminally cleaned yielded positive cultures, patients’ rooms and equipment were not reused until cultures were negative. The measures resulted in a sustained decrease in the resistant strains, but when the policies were relaxed, the pathogen resurged.

"It took five months to contain this drug-resistant organism," Raimondi said. "After containment, [infection control] measures were relaxed, including the use of dedicated staff. Unfortunately, when this was done the [organism reappeared] within six weeks. Reinstitution of these measures was effective, and after a cost analysis, it was determined that it was cheaper to leave them in place. Costs to contain the outbreak were $220,000.

"That included $100,000 for additional dedicated nursing and unit support staff, $112,000 for dedicated supplies and protective equipment, $500 for surveillance cultures, and a one-time $7,000 for new sinks," she said. Costs to the hospital for patients with the drug-resistant infections were some $2 million, including the loss of nearly 300 bed days due to room closings. With a difference of nearly $1.8 million, it was decided that keeping the measures in place was cost-effective.

Rude awakening for pillow ritual

Cost savings can be realized in less dramatic fashion, as discovered by Kim Strelczyk, RN, CIC, an ICP at Harris Methodist Southwest Hospital and Presbyterian Hospital, both of Dallas. The two health care systems merged recently and began the process of reviewing and standardizing products and services. On the product review committee, Strelczyk found that there was gold in . . . pillows?²

"Our biggest success, by far, was on disposable pillows," she told APIC attendees. "These seemed to be the low-hanging fruit that our group needed to make a lot of impact."

More than $240,000 was spent each year on disposable pillows that were used by inpatients and then sent home with them on dismissal, she said.

"There are no real [infection control] issues pertaining to the reuse of pillows," she said. Realizing that the policy was little more than a ritual out of some vague infection control concern, Strelczyk and colleagues stepped in and worked up a cost-saving alternative. The ICPs reassured administration the change could be implemented without negative patient outcomes. They piloted four different reusable pillows and educated housekeeping on proper cleaning and disinfection. The preferred pillow was selected, and an initial cost of $75,000 was incurred to purchase the product. "We selected a pillow that has a cover and the manufacturer recommended could be sprayed and wiped with a disinfectant that is used for the bed and respiratory carts," she said.

"After replacement costs were figured in, we [estimated] annual savings of about $175,000," she told APIC attendees. An extra bonus was that large storage rooms previously dedicated to storage of disposable pillows were freed up for more important items.

"We know the value that infection control practitioners bring to the table when important issues like product selection are being discussed," she said. "At some point in our careers, probably all
of us have learned about some new product that made its way into the hospital without our input."

References

1. Raimondi AD, Koll B, Raucher B, et al. Cost-effective infection control measures to control transmission of multidrug- and pan-drug-resistant Acinetobacter. Session 2402. Presented at the 28th annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC). Seattle; June 2001.

2. Strelczyk, KS, Martin ML. Infection control practitioners collaborate to cut costs. Session 2402. Presented at the 28th annual conference of the association for Professionals in Infection Control and Epidemiology (APIC). Seattle; June 2001.