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Hand Hygiene Noncompliance and the Cost of Hospital‐Acquired Methicillin‐Resistant Staphylococcus aureus Infection

Keith L. Cummings , MD, MBA, Deverick J. Anderson , MD, MPH and Keith S. Kaye , MD, MPH
Infection Control and Hospital Epidemiology
Vol. 31, No. 4 (April 2010), pp. 357-364
DOI: 10.1086/651096
Stable URL: http://www.jstor.org/stable/10.1086/651096
Page Count: 8
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Hand Hygiene Noncompliance and the Cost of Hospital‐Acquired Methicillin‐Resistant Staphylococcus aureus Infection
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Abstract

Background.  Hand hygiene noncompliance is a major cause of nosocomial infection. Nosocomial infection cost data exist, but the effect of hand hygiene noncompliance is unknown. Objective.  To estimate methicillin‐resistant Staphylococcus aureus (MRSA)‐related cost of an incident of hand hygiene noncompliance by a healthcare worker during patient care. Design.  Two models were created to simulate sequential patient contacts by a hand hygiene–noncompliant healthcare worker. Model 1 involved encounters with patients of unknown MRSA status. Model 2 involved an encounter with an MRSA‐colonized patient followed by an encounter with a patient of unknown MRSA status. The probability of new MRSA infection for the second patient was calculated using published data. A simulation of 1 million noncompliant events was performed. Total costs of resulting infections were aggregated and amortized over all events. Setting.  Duke University Medical Center, a 750‐bed tertiary medical center in Durham, North Carolina. Results.  Model 1 was associated with 42 MRSA infections (infection rate, 0.0042%). Mean infection cost was $47,092 (95% confidence interval [CI], $26,040–$68,146); mean cost per noncompliant event was $1.98 (95% CI, $0.91–$3.04). Model 2 was associated with 980 MRSA infections (0.098%). Mean infection cost was $53,598 (95% CI, $50,098–$57,097); mean cost per noncompliant event was $52.53 (95% CI, $47.73–$57.32). A 200‐bed hospital incurs $1,779,283 in annual MRSA infection–related expenses attributable to hand hygiene noncompliance. A 1.0% increase in hand hygiene compliance resulted in annual savings of $39,650 to a 200‐bed hospital. Conclusions.  Hand hygiene noncompliance is associated with significant attributable hospital costs. Minimal improvements in compliance lead to substantial savings.

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