Karolin Graf

Economic aspects of deep sternal wound infections.

OBJECTIVES Surgical-site infections are a very expensive complication in cardiac surgery. Thus, the total costs for coronary artery bypass grafting (CABG) surgery may substantially increase when a deep sternal wound infection (DSWI) occurs. This may be due to an extended length of stay (LOS), the need for additional surgical procedures, vacuum-assisted wound dressing and antibiotic therapy. This study compares the LOS in the hospital and on an intensive care unit (ICU) as well as the total costs for patients undergoing CABG depending upon the occurrence of a subsequent DSWI. METHODS A case-control study was performed. Total costs of DSWI cases were analysed and compared to patients undergoing CABG without DSWI. Inclusion criterion for cases was the development of a DSWI according to the CDC criteria during hospital stay after CABG. Two control patients without any signs or symptoms of an infection during hospital stay were matched to each case by (1) type of surgery according to their diagnosis-related group (DRG), (2) age +/-5 years, (3) gender and (4) duration of preoperative hospital stay +/-2 days, but at least as long as the time at risk of cases before infection. RESULTS Between January 2006 and March 2008, 17 CABG patients with DSWI (cases) and 34 matched controls were included. The median overall costs of a CABG case were 36,261 Euro compared with 13,356 Euro per control patient without infection (p<0.0001). The median overall LOS was 34.4 days versus 16.5 days, respectively (p=0.0006). The median LOS on ICU was 6.3 days versus 5.3 days (no significant difference). CONCLUSION DSWI represents an important economic factor for the hospital as they may almost triple the costs for patients undergoing CABG. Thus, appropriate infection control measures for the prevention of DSWI should be enforced.

Decrease of deep sternal surgical site infection rates after cardiac surgery by a comprehensive infection control program.

When we noticed an increasing incidence of deep sternal surgical site infections (DSSI), a bundle of interdisciplinary infection control measures was initiated in order to prevent further cases of DSSI. Adherence to infection control measures was re-inforced, which included (1) methicillin-resistant Staphylococcus aureus (MRSA) screening, (2) bacterial decolonisation measures, (3) hair clipping instead of shaving, (4) education, (5) good stewardship for antibiotic prophylaxis, (6) change of surgical gloves after sternotomy and after sternal wiring, (7) new bandage techniques, (8) leaving the wound primarily covered for at least 48 h. We checked for potential risk factors in a case-control study (120 patients each) by multivariate analysis. A significant decrease of DSSI from 3.61% (CI 95: 2.98-4.35) down to 1.83% (CI 95: 1.08-2.90) occurred. Independent significant risk factors for DSSI were age >68 years (OR=2.47; CI 95: 1.33-4.60), diabetes mellitus (OR=4.84; CI 95: 2.25-10.4), and intra-operative blood glucose level >8 mmol/l (OR=2.27; CI 95: 1.17-4.42). Protective factors were preoperative antibiotic prophylaxis (OR=0.31; CI 95: 0.13-0.70) and extubation on the day of surgery (OR=0.25; CI 95: 0.11-0.55). Close co-operation between clinical physicians and the infection control team significantly reduced the rate of DSSI. Thus, cardiac surgeons should know the local baseline DSSI rate, e.g. by surveillance, and should be aware of the risk factors for DSSI cases.

Surgical site infections—economic consequences for the health care system

PurposesUnfortunately, surgical site infections (SSIs) are a quite common complication and represent one of the major causes of postoperative morbidity and mortality, and may furthermore lead to enormous additional costs for hospitals and health care systems.MethodsIn order to determine the estimated costs due to SSIs, a MEDLINE search was performed to identify articles that provide data on economic aspects of SSIs and compared to findings from a matched case-control study on costs of SSIs after coronary bypass grafting (CABG) in a German tertiary care university hospital.ResultsA total of 14 studies on costs were found. The additional costs of SSI vary between

The prevalence of nosocomial and community acquired infections in a university hospital: an observational study.

3,859 (mean) and

Sternal surgical site infection prevention – is there any room for improvement?

40,559 (median). Median costs of a single CABG case in the recently published study were

Prevention of Early Vascular Graft Infection Using Regional Antibiotic Release

49,449 (€36,261) vs.

Beliefs about hand hygiene: A survey in medical students in their first clinical year

18,218 (€13,356) in controls lacking infection (p < 0.0001). The median reimbursement from health care insurance companies was

Economic implications of infections of implantable cardiac devices in a single institution.

36,962 (€27,107) leading to a financial loss of

Hand hygiene compliance in transplant and other special patient groups: An observational study

12,482 (€9,154) each.ConclusionCosts of SSIs may almost triple the individual overall health care costs and those additional charges may not be sufficiently covered. Appropriate measures to reduce SSI rates must be taken to improve the patient’s safety. This should also diminish costs for health care systems which benefits the entire community.

An outbreak of Clostridium difficile -associated disease (CDAD) in a German university hospital

BACKGROUND Nosocomial infections (NI) increase morbidity and mortality. Studies of their prevalence in single institutions can reveal trends over time and help to identify risk factors. METHODS In March and April 2010, data were prospectively recorded from all inpatients at the Hannover Medical School (Germany) except those treated in the pediatric, psychosomatic, and psychiatric services. The data were acquired systematically by chart review and by interviews with the medical staff. Infections were classified according to the definitions of the Centers for Disease Control and Prevention (CDC). Information was obtained on underlying diseases, invasive procedures, the use of antibiotics, devices (the application of specific medical techniques such as drainage, vascular catheters, etc.), and detected pathogens. RESULTS Of the 1047 patients studied, 117 (11.2%) had a total of 124 nosocomial infections, while 112 (10.7%) had 122 community-acquired infections. The most common NI were surgical site infections (29%), infections of the gastrointestinal tract (26%) and respiratory tract (19%), urinary tract infections (16%), and primary sepsis (4%). The most common pathogens were Escherichia coli, coagulase-negative staphylococci, Candida spp., Enterococcus spp., and Pseudomonas aeruginosa. Multivariable regression analysis revealed the following independent risk factors for NI: antibiotic treatment in the last 6 months (odds ratio [OR] = 2.9), underlying gastrointestinal diseases (OR = 2.3), surgery in the last 12 months (OR = 1.8), and more than two underlying diseases (OR = 1.7). Each additional device that was used gave rise to an OR of 1.4. Further risk factors included age, length of current or previous hospital stay, trauma, stay on an intensive care unit, and artificial ventilation. CONCLUSION In this prevalence study, NI were a common complication. Surgical site infections were the single most common type of NI because of the large number of patients that underwent surgical procedures in our institution. More investigation will be needed to assess the benefit of prevalence studies for optimizing appropriate, effective preventive measures.