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2019 HSR&D/QUERI National Conference Abstract

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4149 — Cost-Effectiveness Analysis of Additional Cleaning Time of Hospital Contact Precautions Rooms

Lead/Presenter: Ann Chou,  COIN - Los Angeles
All Authors: Chou AnnF (University of Oklahoma Health Sciences Center), Kinney S (University of Oklahoma Health Sciences Center), Kim SE (University of Southern California) Cuellar AE (George Mason University) Wendelboe AM (University of Oklahoma Health Sciences Center)

Objectives:
Studies using national data have reported dramatic increases in Clostridium difficile infection (CDI) in community hospitals in recent years, observing a near doubling of CDI incidence over a ten-year period. CDI incidence has also seen a dramatic rise among Veterans, with a 19% increase in CDI episodes over five-years. Contact precaution rooms previously occupied by a C. difficile infected patients would require additional cleaning steps/time. Compliance with recommendations has been shown to reduce room-to-patient transmission risk of not only C. difficile, but also methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococcus (VRE). However, most facilities do not allot additional time for cleaning contact precaution rooms. This study aims to determine and estimate cost savings from risk reduction as a result of additional cleaning.

Methods:
We estimated the financial impact of allowing hospital housekeepers an additional 15 minutes to terminally clean these rooms. We constructed a cost-effectiveness model to calculate costs associated with additional cleaning time. Parameters included the cost and incremental probability of the Emergency Department going on divert, the cost of room cleaning, the percent risk reduction, and the cost of infection. Our primary model focused on CDI and measures for MRSA and VRE were included in sensitivity analyses.

Results:
Using the midpoint values, implementing an enhanced cleaning protocol saved the hospital $513 per terminally-cleaned room when accounting for only CDI. When including MRSA and VRE, savings increased to $884 per room. The model was most sensitive to the cost of CDI, reduction in transmission risk, and incremental probability the ED goes on divert.

Implications:
Giving housekeepers an extra 15 minutes to terminally clean contact precautions rooms is cost effective in meeting infection control standards.

Impacts:
Within VA, CDI incidence has increased from 1.6 per 10,000 in FY 2003 to 5.1 per 10,000 in FY 2013. Recurrence incidence has increased 10-fold over an 11-year period, from 0.1 per 10,000 in FY 2003, to 1.0 per 10,000 in FY 2014. These results may assist in infection control strategic decision-making of resource allocation. Given the high CDI burden among Veterans, savings generated from allowing additional cleaning time may be significant.