Hospitals face multiple challenges when it comes to effectively combating infections on a system-wide basis. Antibiotic resistance, healthcare-acquired infections, and cross-contamination of reusable medical equipment between patients are prime examples.
In addition to the very serious, sometimes life-threatening, infection risk to patients, healthcare workers, and others, inadequate infection control can be costly.
Resisting the Spread of Resistant Infections
Antibiotic stewardship programs take aim directly at inappropriate use of these agents, and save significant money at the same time. A June 2017 Forbes piece, “The Forgotten $35 Billion U.S. Healthcare Problem,” attributes the cost to lost wages, premature deaths and hospital stays—and that’s in 2008 dollars.1
In the United States, the CDC estimates the cost of antimicrobial resistance as $55 billion per year overall, including $20 billion in excess, direct healthcare costs.2 In Europe, antibiotic resistance costs an estimated 1.5 billion euros, including more than 900 million euros corresponding to hospital costs to fight these infectious agents.
The big picture of antibiotic resistance is of course global, and best practices call for a coordinated effort among clinicians, health-systems, and countries. Even if the United States successfully drives down rates of antibiotic resistance, the benefits will be limited if other countries do not mount similar efforts.
Antibiotic resistant bacteria are responsible for two million or more illnesses in the United States each year and 23,000 deaths, according to a Joint Commission report.3 And with only an estimated 40% to 50% of U.S. hospitals armed with a comprehensive antibiotic stewardship program,4 clearly more needs to be done.
Learning from the Successes of Others
Successful antibiotic stewardship programs at hospitals nationwide have some common features—they get buy-in from administration; they emphasize staff and patient education; and they generate ideas from a multidisciplinary team of critical care doctors, infectious disease experts, pharmacists, nurses, and others. They also design interventions that remain sustainable over time.
University of California, Davis Medical Center
Like many hospitals that launch an antibiotic stewardship program, the 619-bed academic hospital focused on judicious antibiotic use and other tactics to reduce their hospital-acquired Clostridium difficile infection rates. “In its first year, the antibiotic resistance program achieved a 23 percent reduction in C. difficile rates.” Hien Huy Nguyen, University of California, Davis, said in a Pew Charitable Trust report.5 Their efforts resulted in a total estimated savings of $23,540.
C diff is a leading culprit. According to a CDC-funded study, in 2011 there were an estimated 107,000 cases of hospital-acquired C-diff infections nationwide, with 50,000 estimated deaths, representing a cost of more than $1 billion to the American healthcare system.6
In the first year that UC Davis expanded their antibiotic stewardship program, the team recommended 2,068 interventions and clinicians accepted 92%, primarily around de-escalating or stopping antibiotic use. Another 1 in 5 recommendations focused on antibiotic escalation or optimization of the regimen. The program also reduced use of 11 broad-spectrum and expensive antibiotics by 8%, resulting in another $119,000 in savings.
Kenmore Mercy Hospital
Kenmore Mercy Hospital in Buffalo, New York created a formal antibiotic stewardship program in 2012. The move came after Catholic Health System, which includes Kenmore, became a Medicare ACO and started searching for quality improvement initiatives.
The first year of the program saw savings in excess of $145,000 on drug purchasing alone at the 184-bed hospital7. In addition, pharmacist-initiated I.V.-to-oral conversions of antibiotic prescriptions increased 688% compared to the previous year. Physicians accepted the recommendations of infectious-disease experts nearly three-quarters of the time.
Staff education was also essential to the program’s success. The physicians group provided infectious disease support and educated other doctors and pharmacists regarding best practices. Daily meetings and rotating the lead stewardship role among the pharmacists also contributed to their success.
St. Tammany Parish Hospital, Covington, Louisiana
A 244-bed community hospital similarly designed its antibiotic stewardship program to target C diff rates. They significantly decrease their rate from 8.9 cases per 10,000 patient days to 6.4 cases per 100 patient-days over a year.5
The stewardship team also identified certain antimicrobials they believed were overprescribed. The program prompted reductions between 61 percent and 86 percent in daptomycin, linezolid, tigecyclyine, and micafungin.
The intervention also reduced the average antimicrobial cost per patient day from $25.93 at its peak to $8.32 per patient-day. The hospital saved $1.3 million in the first 18 months of the program, more than offsetting the staff time devoted to the antibiotic stewardship program.
Taking Action Against Hospital-Acquired Infections
At the same time, hospitals continue to fight inappropriate use and resistance of antibiotics, they also need to combat hospital-acquired infections (HAIs). Slashing the high rate of these infections is not only important for patient safety, health outcomes, and higher quality rankings, but it’s a matter of economics as well.
C. diff. is not the only challenging and expensive HAI to treat. Ventilator-associated pneumonia adds $10,000 to $25,000 in costs to each case treated in the United States, the World Health Organization estimates. There are also catheter-related bloodstream infections, with total costs estimated at $2.3 billion in the U.S., €53.9 million in the United Kingdom and €130 million in France. The economic seriousness of these infections quickly becomes apparent.
The dire picture can be improved, however, with a concerted effort that focuses on best practices. Use of disposable medical devices versus reusable equipment, for example, eliminates the risk of cross-contamination between patients.
Visit the Ambu site to find out more about anesthesia, emergency care and patient monitoring and diagnostic products that are single-use, sterile out of the package, and economically similar to reusable devices, according to a number of cost analysis studies.
1. The Forgotten $35 Billion U.S. Healthcare Problem. Forbes. June 27, 2017. https://www.forbes.com/sites/nicolefisher/2017/06/27/the-forgotten-35-billion-u-s-health-care-problem/#3ba0e4342ee4
2. World Health Organization Report on the Burden of Endemic Health Care-Associated Infection Worldwide. 2011. http://apps.who.int/iris/bitstream/10665/80135/1/9789241501507_eng.pdf?ua=1
3. Joint Commission. New antimicrobial stewardship standard. R3 Report 2016;(8): https://www.jointcommission.org/r3_issue_8/
4. Nearly 40% of Hospitals Have Antibiotic Stewardship Programs. Medscape Medical News, May 26, 2016. https://www.medscape.com/viewarticle/863866
5. A Path to Better Antibiotic Stewardship in Inpatient Settings. Pew Charitable Trusts report, April 2016. http://www.pewtrusts.org/~/media/assets/2016/04/apathtobetterantibioticstewardshipininpatientsettings.pdf
6. Burden of Clostridium difficile Infection in the United States. N. Engl. J. Med. 2015;372:825-34. http://www.nejm.org/doi/full/10.1056/NEJMoa1408913
7 . Hospitals focus on antibiotic overuse as CMS prepares new mandate. Modern Healthcare. December 20, 2014. http://www.modernhealthcare.com/article/20141220/MAGAZINE/312209980
8. Cost analysis of single-use (Ambu® aScope™) and reusable bronchoscopes in the ICU. Ann. Intensive Care. 2017;7:3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5209315/
9. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit. Care Med. 2003;31;1312-7. https://www.ncbi.nlm.nih.gov/pubmed/12771596
10. Cost analysis comparing single-use (Ambu® aScope™) and conventional reusable fiberoptic flexible scopes for difficult tracheal intubation. Ann. Fr. Anest. Reanim. 2013;32:291-5. https://www.ncbi.nlm.nih.gov/pubmed/23561716