Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Infect Control Hosp Epidemiol. 2010 Apr;31(4):357-64. doi: 10.1086/651096.
Hand hygiene noncompliance is a major cause of nosocomial infection. Nosocomial infection cost data exist, but the effect of hand hygiene noncompliance is unknown.
To estimate methicillin-resistant Staphylococcus aureus (MRSA)-related cost of an incident of hand hygiene noncompliance by a healthcare worker during patient care.
Two models were created to simulate sequential patient contacts by a hand hygiene-noncompliant healthcare worker. Model 1 involved encounters with patients of unknown MRSA status. Model 2 involved an encounter with an MRSA-colonized patient followed by an encounter with a patient of unknown MRSA status. The probability of new MRSA infection for the second patient was calculated using published data. A simulation of 1 million noncompliant events was performed. Total costs of resulting infections were aggregated and amortized over all events.
Duke University Medical Center, a 750-bed tertiary medical center in Durham, North Carolina.
Model 1 was associated with 42 MRSA infections (infection rate, 0.0042%). Mean infection cost was $47,092 (95% confidence interval [CI], $26,040-$68,146); mean cost per noncompliant event was $1.98 (95% CI, $0.91-$3.04). Model 2 was associated with 980 MRSA infections (0.098%). Mean infection cost was $53,598 (95% CI, $50,098-$57,097); mean cost per noncompliant event was $52.53 (95% CI, $47.73-$57.32). A 200-bed hospital incurs $1,779,283 in annual MRSA infection-related expenses attributable to hand hygiene noncompliance. A 1.0% increase in hand hygiene compliance resulted in annual savings of $39,650 to a 200-bed hospital.
Hand hygiene noncompliance is associated with significant attributable hospital costs. Minimal improvements in compliance lead to substantial savings.
手部卫生不合规是医院感染的主要原因。虽然存在医院感染成本数据，但手部卫生不合规的影响尚不清楚。
估算医护人员在患者护理过程中手部卫生不合规导致耐甲氧西林金黄色葡萄球菌（MRSA）感染的相关成本。
创建了两个模型来模拟手部卫生不合规的医护人员连续接触患者的情况。模型 1 涉及接触未知 MRSA 状态的患者，模型 2 涉及接触 MRSA 定植患者，然后接触未知 MRSA 状态的患者。使用已发表的数据计算第二位患者发生新的 MRSA 感染的概率。对 100 万次不合规事件进行模拟。将所有事件的感染总成本进行汇总并摊销。
北卡罗来纳州达勒姆市拥有 750 张床位的三级医疗中心杜克大学医学中心。
模型 1 导致 42 例 MRSA 感染（感染率为 0.0042%）。平均感染成本为 47092 美元（95%置信区间[CI]，26040 美元-68146 美元）；每次不合规事件的平均成本为 1.98 美元（95%CI，0.91 美元-3.04 美元）。模型 2 导致 980 例 MRSA 感染（0.098%）。平均感染成本为 53598 美元（95%CI，50098 美元-57097 美元）；每次不合规事件的平均成本为 52.53 美元（95%CI，47.73 美元-57.32 美元）。一家 200 张床位的医院因手部卫生不合规导致的耐甲氧西林金黄色葡萄球菌感染相关费用，每年支出 1779283 美元。一家 200 张床位的医院，如果手部卫生依从性提高 1%，每年可节省 39650 美元。
手部卫生不合规与显著的可归因医院成本相关。合规性的微小提高即可带来大量节省。
