Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK.
Safeguarding Health Through Infection Prevention Research Group, Glasgow Caledonian University, Glasgow, UK.
J Hosp Infect. 2021 Aug;114:51-58. doi: 10.1016/j.jhin.2020.12.026.
Whereas the cost burden of healthcare-associated infection (HAI) extends beyond the inpatient stay into the post-discharge period, few studies have focused on post-discharge costs.
To investigate the impact of all types of HAI on the magnitude and distribution of post-discharge costs observed in acute and community services for patients who developed HAI during their inpatient stay.
Using data from the Evaluation of Cost of Nosocomial Infection (ECONI) study and regression methods, this study identifies the marginal effect of HAI on the 90-daypost-discharge resource use and costs. To calculate monetary values, unit costs were applied to estimates of excess resource use per case of HAI.
Post-discharge costs increase inpatient HAI costs by 36%, with an annual national cost of £10,832,437. The total extra cost per patient with HAI was £1,457 (95% confidence interval: 1,004-4,244) in the 90 days post discharge. Patients with HAI had longer LOS if they were readmitted and were prescribed more antibiotics in the community. The results suggest that HAI did not have an impact on the number of readmissions or repeat surgeries within 90 days of discharge. The majority (95%) of the excess costs was on acute care services after readmission. Bloodstream infection, gastrointestinal infection, and pneumonia had the biggest impact on post-discharge cost.
HAI increases costs and antibiotic consumption in the post-discharge period. Economic evaluations of IPC studies should incorporate post-discharge costs. These findings can be used nationally and internationally to support decision-making on the impact of IPC interventions.
医疗保健相关感染（HAI）的成本负担不仅限于住院期间，还延伸到出院后期间，但很少有研究关注出院后的成本。
调查所有类型的 HAI 对住院期间发生 HAI 的患者在急性和社区服务中观察到的出院后成本的规模和分布的影响。
本研究使用来自医院感染成本评估（ECONI）研究的数据和回归方法，确定 HAI 对 90 天出院后资源使用和成本的边际效应。为了计算货币价值，应用单位成本来估计每例 HAI 的超额资源使用。
出院后成本使住院 HAI 成本增加了 36%，全国每年的成本为 10832437 英镑。出院后 90 天内每例 HAI 患者的总额外费用为 1457 英镑（95%置信区间：1004-4244）。如果患者再次入院，并且在社区中开了更多的抗生素，那么他们的 LOS 会更长。结果表明，HAI 并没有影响出院后 90 天内的再入院或重复手术次数。超过 95%的超额费用发生在再次入院后的急性护理服务上。血流感染、胃肠道感染和肺炎对出院后成本的影响最大。
HAI 增加了出院后的成本和抗生素消耗。IPC 研究的经济评估应纳入出院后成本。这些发现可在国家和国际范围内用于支持关于 IPC 干预措施影响的决策。
