Multifaceted Cost of Infection
Depending on who you are and what you do, the phrase, “infection costs” could have different meanings.
It could be taken literally: the financial burden of infections. You could take a more philosophical approach, the cost to the person suffering from infection (physically, mentally, psychologically). It could reflect a more “jaded” image of the physical and mental stress of a caregiver. Whatever your first impression, it’s easy to recognize that the cost of an infection is a price all of us would rather not pay, especially when that price tag includes the loss of life.
Searching for Answers
I recently posted the question, “how much do you think an infection costs in a hospital or LTC/SNF?” to a popular social media group made up of fellow nurses and healthcare workers. I wanted to know what others in the medical field, particularly nurses, thought infection costs involved. Unfortunately, most just read the question and moved on, but the few who did answer, posed their own questions: “what do you mean?” and “I’m confused?”. The costs of infections are not even on the radar for most nurses; but ask “how do you prevent the spread of infection?” and get a flood of “handwashing” among other answers. The result of my little experiment? I learned that sometimes, it’s more about asking the right question and that nurses do contribute to lessening the burden of infections costs. Nurses can, and do, impact infection costs whether it be financial, physical or philosophical by aiding in the prevention of Healthcare Associated Infections (HAIs).
The Life of a Nurse
I am a nurse by trade and I remember being a new nurse with my “save the world, no matter the costs” outlook. After all, how do you put a price tag on someone’s life or well-being? However, as my profession and, by necessity, position grew; I began to understand the nuances of running a business as well. If my co-workers and I wanted to be paid, there had to be money made. I’ve come to recognize while saving money may not be the only answer, it’s something we can all contribute to. Saving money on infection costs by decreasing the spread of infection is one way to do it.
Food For Thought
As a SmartSteward team, we have looked at the question of infection costs. We’ve brain-stormed and discussed measuring the cost of infection, what’s involved, and researched what others have found. Unfortunately, there is little data on the costs of infections. Most studies are hospital based and use retrospective studies looking at reimbursement data of diagnostic and medication costs. However, we came up with a much broader definition of the costs of infections. The literal costs of the financial burden of caring for someone with an infection, including: extra medication and treatment costs, the use of more equipment or devices, the costs of diagnostic data such as lab tests, cultures, and/or x-rays, increased doctor’s visits, maybe even a specialist or consult is included. However, the most costly, financially and otherwise, is the extra time, effort, stress, and sometimes escalation of the healthcare staff. When a patient becomes ill with a HAI, it sets off a series of events including speaking with the doctor, the family, providing extra care, establishing any precautions that may be needed, ordering new and/or different medications and/or diagnostic testing, and the list goes on and on. Someone has to initiate and carry out all of those tasks while caring for the patient and, sometimes, the family as well. This is a burden healthcare staff readily accept, it’s what we are here for; but it also means increased time and stress which may lead to burn-out, staff turn-over, and increased over-time.
The Real Costs of Infections
As Hamlet said, “Ay, there’s the rub” (Hamlet, 2015), infection costs are not limited to medications, treatments, labs, or x-rays. No, it’s embodied in the “boots on the ground” caregivers that are working hard to, not only care for the patient and family, but prevent the HAI from spreading to anyone else. This is where the real financial costs lie for a facility: The increased time spent by the nursing staff and the increased burden on the staff leading to more costly turn-over, over time and burnout. Ethically, the ultimate price to pay for infection is loss of life. I could list statistics of HAI death rate, the rate of HAI and the rate of those infections that result in death or debility; but to my nurse’s heart, any loss of life is too high a price to pay, especially when it is preventable.
Increased Costs of Resistance
While infection costs as a whole does not have enough reliable data, one of the aspects of infection costs has been recorded more than most: HAIs of the resistant variety. Some studies have shown that antimicrobial resistance increase overall infection costs and we have found this to be true in our own data by about 10x. When looking at the average cost of a non-resistant versus a resistant organism, the costs rise with the need for more expensive antibiotics, I.V. antibiotics (I.V. supplies), more testing, and isolation precautions. How do you combat antibiotic resistance? The easy answer: stop using antibiotics, but obviously, the full answer is more complicated. Antibiotics are great, when used properly and only when needed; but antibiotics can actually cause infection as well as other complications.
What does it all mean?
Why is the SmartSteward team researching the costs of infections and how it impacts facilities? Because we want to be the answer to the follow-up question: “how do we reduce the costs of infections?” Through our 24/7/365 surveillance system with notification of potential outbreaks as well as the ability for the Infection Control and Prevention Officer (ICPO) to monitor all infection events quickly and easily; SmartSteward can enable the ICPO to detect and prevent the spread of HAIs. In addition, the SmartSteward software decreases the time spent on gathering and processing data thereby allowing the ICPO to process and use surveillance data in real time. SmartSteward also has a one-of-a-kind recommendation engine for prescribing antibiotics as well as a feedback system for the prescribers creating a “one-stop shop” for antimicrobial stewardship that leads to a reduction in resistance.
Opening Doors to The Future
Infection costs, antibiotic resistance and antimicrobial resistance costs are not unheard of. Government agencies, such as the Centers for Disease Control and Prevention (CDC), the Centers for Medicaid and Medicare (CMS), and even the World Health Organization (WHO) continue to address the growing problem of infection costs. The most recent move by CMS began in 2014 with initiating rule and regulation changes surrounding infection control and prevention and antibiotic stewardship. The changes did not happen quickly, but has been spread out over the course of years culminating this year. However, as more information, guidelines, and regulations come from the continued rise in infection and antibiotic resistance awareness, payment and regulatory systems will continue to depend on the decline of infection rate and resistance in each facility. Without constant and consistent surveillance and tools for antibiotic stewardship, this is nearly impossible. SmartSteward is your all-in-one infection control and prevention and antibiotic stewardship partner in regulatory compliance and costs saving.
Hamlet by William Shakespere. (2015). Retrieved on 13 September 2019 from https://www.williamshakespeare.net/hamlet.jsp