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PEDIATRICS Vol. 106 No. 3 September 2000, pp. 520-526

Nosocomial Respiratory Syncytial Virus Infections: The Cost-Effectiveness and Cost-Benefit of Infection Control

Received Nov 23, 1999; accepted Feb 1, 2000.

Kristine K. Macartney*, Marc H. GorelickDagger , Mary Lou Manning§, Richard L. Hodinkaparallel , and Louis M. Bell

From the * Division of Immunologic and Infectious Diseases, Children's Hospital of Philadelphia, and University of Pennsylvania School of Medicine; Dagger  Department of Emergency Medicine, Alfred I. du Pont Hospital for Children, Department of Pediatrics, Jefferson Medical College, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania; § Departments of Infection Control and Occupational Health, Children's Hospital of Philadelphia, and University of Pennsylvania School of Nursing; parallel  Department of Clinical Virology, Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine; and  Department of Infection Control, Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Objective.  To determine the cost-effectiveness and cost-benefit of an infection control program to reduce nosocomial respiratory syncytial virus (RSV) transmission in a large pediatric hospital.

Design.  RSV nosocomial infection (NI) was studied for 8 years, before and after intervention with a targeted infection control program. The cost-effectiveness of the intervention was calculated, and cost-benefit was estimated by a case-control comparison.

Setting.  Children's Hospital of Philadelphia, a 304-bed pediatric hospital.

Patients.  All inpatients with RSV infection, both community- and hospital-acquired.

Intervention.  Consisted of early recognition of patients with respiratory symptoms, confirmation of RSV infection by laboratory testing, establishing cohorts of patients and nursing staff, gown and glove barrier precautions, and monitoring and education of staff.

Outcome Measures.  The incidence density of RSV NI before and after the intervention was calculated as the rate per 1000 patient days-at-risk for infection. Intervention costs included laboratory testing, isolation, and administration of the program. The cost of RSV NI was estimated by comparing hospital charges for 30 cases and matched uninfected controls.

Results.  A total of 148 patients acquired NI (88 before and 60 after the intervention). The Mantel-Haenszel stratified relative risk for NI in the period before the infection control program, compared with the postintervention period, was .61 (95% confidence interval: .53-.69). By applying the preintervention stratum-specific rates of infection to the days-at-risk in the postintervention period, an estimated 100 NIs would have been expected, which in comparison to the 60 NIs observed, yielded an estimated program effectiveness of 10 RSV NIs prevented per season. The total cost of the program per season was $15 627 or $1563/NI prevented. In comparison, the mean cost to the hospital was $9419/case of RSV NI, resulting in a cost-benefit ratio of 1:6.

Conclusions.  A targeted infection control intervention was cost-effective in reducing the rate of RSV NI. For every dollar spent on the program, approximately $6 was saved.  Key words:  respiratory syncytial virus, nosocomial infection, infection control, cost-effectiveness, cost-benefit.




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