Abstract:
BACKGROUND:Surgical site infections (SSIs) are common surgical complications that lead to increased costs. Depending on payer type, however, they do not necessarily translate into deficits for every hospital. OBJECTIVE:We investigated how surgical site infections (SSIs) influence the contribution margin in 2 reimbursement systems based on diagnosis-related groups (DRGs). METHODS:This preplanned observational health cost analysis was nested within a Swiss multicenter randomized controlled trial on the timing of preoperative antibiotic prophylaxis in general surgery between February 2013 and August 2015. A simulation of cost and income in the National Health Service (NHS) England reimbursement system was conducted. RESULTS:Of 5,175 patients initially enrolled, 4,556 had complete cost and income data as well as SSI status available for analysis. SSI occurred in 228 of 4,556 of patients (5%). Patients with SSIs were older, more often male, had higher BMIs, compulsory insurance, longer operations, and more frequent ICU admissions. SSIs led to higher hospital cost and income. The median contribution margin was negative in cases of SSI. In SSI cases, median contribution margin was Swiss francs (CHF) -2045 (IQR, -12,800 to 4,848) versus CHF 895 (IQR, -2,190 to 4,158) in non-SSI cases. Higher ASA class and private insurance were associated with higher contribution margins in SSI cases, and ICU admission led to greater deficits. Private insurance had a strong increasing effect on contribution margin at the 10th, 50th (median), and 90th percentiles of its distribution, leading to overall positive contribution margins for SSIs in Switzerland. The NHS England simulation with 3,893 patients revealed similar but less pronounced effects of SSI on contribution margin. CONCLUSIONS:Depending on payer type, reimbursement systems with DRGs offer only minor financial incentives to the prevention of SSI.
journal_name
Infect Control Hosp Epidemioljournal_title
Infection control and hospital epidemiologyauthors
von Strauss M,Marti WR,Mujagic E,Coslovsky M,Diernberger K,Hall P,Zeindler J,Salm LA,Soysal SD,Mechera R,von Holzen U,Weber WPdoi
10.1017/ice.2019.273subject
Has Abstractpub_date
2019-12-01 00:00:00pages
1374-1379issue
12eissn
0899-823Xissn
1559-6834pii
S0899823X19002733journal_volume
40pub_type
杂志文章,多中心研究,随机对照试验abstract::We analyzed antibiotic use data from 29 southeastern US hospitals over a 5-year period to determine changes in antibiotic use after the fluoroquinolone US Food and Drug Administration (FDA) advisory update in 2016. Fluoroquinolone use declined both before and after the FDA announcement, and the use of select, alternat...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1017/ice.2019.247
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:The anterior nares are the most sensitive single site for detecting methicillin-resistant Staphylococcus aureus (MRSA) colonization. Colonization patterns of USA300 MRSA colonization are unknown. OBJECTIVES:To assess whether residents of extended care facilities who are colonized with USA300 MRSA have diffe...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/596114
更新日期:2009-04-01 00:00:00
abstract:OBJECTIVES:To determine the predictors of 7-day mortality in older adult patients with Staphylococcus aureus bacteremia after controlling for comorbidity using the Charlson weighted index of comorbidity (WIC) and to identify the risk factors associated with bacteremia due to methicillin-resistant S. aureus (MRSA). DES...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/507924
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:Most nosocomial acquistion of vancomycin-resistant enterococci (VRE) is due to cross-transmission. We sought to identify risk factors for acquisition of VRE by roommates of patients colonized or infected with VRE. DESIGN:Retrospective cohort study. SETTING:A 472-bed tertiary care teaching hospital. METHODS...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/587187
更新日期:2008-05-01 00:00:00
abstract::We investigated an outbreak of postoperative shoulder arthritis due to Propionibacterium acnes infection in nondebilitated patients. Risk factors were male sex, the order in which surgery was performed during the daily operating schedule, and increased duration of the surgical procedure. After modification of the vent...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/507287
更新日期:2006-09-01 00:00:00
abstract::Infection control in the long-term-care facility has expanded substantially since "Topics in Long-Term Care" debuted in this journal in 1989. This section has been on hiatus, but now, after a 4-year lag, resumes its exploration of these topics. In the first article, endemic and epidemic infections in long-term care ar...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/647831
更新日期:1998-05-01 00:00:00
abstract::We assessed the ability of a standard disinfection procedure to eliminate hepatitis C virus (HCV) from the air-water channel of hysteroscopes. The residual HCV RNA remaining after the disinfection procedure was measured by polymerase chain reaction. When correctly applied to hysteroscopes, the standard disinfection pr...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/501649
更新日期:1999-06-01 00:00:00
abstract::We investigated the source of infection in a patient who developed acute hepatitis C virus infection after cardiothoracic surgery. A healthcare worker was found to be infected with hepatitis C virus, and molecular analysis indicated the strain was similar to that found in the patient. The exact mode of transmission wa...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/510807
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVE:To investigate the possibility that contaminated commercial activated charcoal may serve as a source for fungal colonization or infection of the lower respiratory tract. DESIGN:The clinical course of a patient who aspirated commercial activated charcoal was reviewed. Fungal cultures were performed for 2 samp...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/646281
更新日期:1991-12-01 00:00:00
abstract:OBJECTIVE:Ertapenem exposure has been reported to select for cross-resistance to other carbapenems in Pseudomonas aeruginosa in vitro. Single-center investigations report conflicting results. We evaluated ertapenem use and antipseudomonal carbapenem susceptibility for 6 years spanning the time of ertapenem adoption at ...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章,多中心研究
doi:10.1086/652154
更新日期:2010-05-01 00:00:00
abstract::Monsel's solution is a common topically applied hemostatic agent used in minor dermatologic and gynecologic surgery. Clinically, because it is often stored for long periods and dispensed from a common source for multiple patients, Monsel's solution is a potential vector for transmission of infection. However, microbio...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/502180
更新日期:2003-02-01 00:00:00
abstract::OBJECTIVE National hospital performance measures for C. difficile infection (CD) are available; comparing antibacterial use among performance levels can aid in identifying effective antimicrobial stewardship strategies to reduce CDI rates. DESIGN Hospital-level, cross-sectional analysis. METHODS Hospital characteristi...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1017/ice.2016.87
更新日期:2016-08-01 00:00:00
abstract::OBJECTIVE To compare central line use and central line-associated bloodstream infection in newborn infants before and after the introduction of a central line infection prevention bundle in order to determine the effectiveness of the bundle and to identify areas for further improvement. DESIGN Retrospective cohort ana...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1017/ice.2016.127
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVE:To describe an outbreak of hepatitis C in a clinical research study. DESIGN:Observational study. SETTING:Tertiary-care hospital. PATIENTS:Healthcare workers who volunteered to be subjects in a study of the metabolic effects of inhaled and oral corticosteroids who were unwittingly exposed to hepatitis C vir...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/501848
更新日期:2001-11-01 00:00:00
abstract:BACKGROUND:States have established public reporting of hospital-associated (HA) infections-including those of methicillin-resistant Staphylococcus aureus (MRSA)-but do not account for hospital case mix or postdischarge events. OBJECTIVE:Identify facility-level characteristics associated with HA-MRSA infection admissio...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/678069
更新日期:2014-10-01 00:00:00
abstract:OBJECTIVE:To study the relationship between serum high-density lipoprotein cholesterol (HDL-C), total serum cholesterol, and nosocomial infection in patients undergoing general surgery. DESIGN:Prospective cohort study, with an extended follow-up to 1 month after hospital discharge. SETTING:The general surgery service...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/647494
更新日期:1997-01-01 00:00:00
abstract::Annual surveillance data (2007-2015), collected continuously in 132 German hospitals, was evaluated for development of alcohol-based hand-rub consumption (AHC) as a surrogate parameter for hand hygiene adherence. Overall, the median increase in AHC was 94%. The increases over 9 years were significant in all units and ...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1017/ice.2017.71
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Antibiotics are overprescribed for acute respiratory tract infections (ARIs). Guidelines provide criteria to determine which patients should receive antibiotics. We assessed congruence between documentation of ARI diagnostic and treatment practices with guideline recommendations, treatment appropriateness, a...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1017/ice.2019.16
更新日期:2019-04-01 00:00:00
abstract::This study reports an investigation of outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization involving 17 newborns in the neonatal unit of a teaching hospital. A neonatal specialist colonized with MRSA that eventually became mupirocin-resistant was implicated as a recurrent source ...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/513616
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVE:Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging multidrug-resistant pathogen associated with higher mortality, longer hospital stays, and increased costs. CRKP was thought to be sporadic in Los Angeles County (LAC); however, the actual incidence is unknown. To address this, LAC declared CRKP ...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/669087
更新日期:2013-02-01 00:00:00
abstract:OBJECTIVE:To determine the extent to which evidence-based practices for the prevention of central venous catheter (CVC)-associated bloodstream infections are incorporated into the policies and practices of academic intensive care units (ICUs) in the United States and to determine variations in the policies on CVC inser...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章,多中心研究
doi:10.1086/499151
更新日期:2006-01-01 00:00:00
abstract::We describe an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) ST398 in a nursing home in the Netherlands. Seven residents and 4 healthcare workers were identified with MRSA ST398, but 2 of the healthcare workers carried other strains. This study demonstrates that MRSA ST398 can spread in nursing homes....
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/665726
更新日期:2012-06-01 00:00:00
abstract:OBJECTIVE:To describe the use of laminar airflow, body exhaust, and ultraviolet lights during total knee replacement (TKR) in four U.S. states. DESIGN:Survey of healthcare facilities. SETTING:Hospitals in Illinois, North Carolina, Ohio, and Tennessee that performed TKR during 2000 as identified by Medicare claims dat...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章,多中心研究
doi:10.1086/505452
更新日期:2005-12-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Fluoroquinolones have not been frequently implicated as a cause of Clostridium difficile outbreaks. Nosocomial C. difficile infections increased from 2.7 to 6.8 cases per 1000 discharges (P < .001). During the first 2 years of the outbreak, there were 253 nosocomial C. difficile infections; of ...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/502539
更新日期:2005-03-01 00:00:00
abstract::The rate of purified protein derivative (PPD) conversion in workers at our hospital increased to 1.7% in 1991. After implementation of mandatory respiratory isolation of patients with community-acquired pneumonia, the rate dropped to 0.6%. This policy may protect workers in institutions where the majority of patients ...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/647675
更新日期:1997-08-01 00:00:00
abstract:OBJECTIVE:In-hospital transmission of methicillin-susceptible Staphylococcus aureus (MSSA) among neonates remains enigmatic. We describe the epidemiology of MSSA colonization and infection in a 30-bed neonatal ward. DESIGN:Multimodal outbreak investigation SETTING:A public 800-bed tertiary care university hospital in...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1017/ice.2015.184
更新日期:2015-11-01 00:00:00
abstract::A point prevalence survey was conducted on May 11, 2017, among inpatients at 6 hospitals in Saudi Arabia. The overall point prevalence was 6.8% (114 of 1,666). The most common types of infections were pneumonia (27.2%), urinary tract infections (20.2%), and bloodstream infections (10.5%). Approximately 19.2% of health...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1017/ice.2018.338
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:To determine the prevalence of central venous catheter (CVC) use among patients both within and outside the ICU setting. DESIGN:A 1-day prevalence survey of CVC use among adult inpatients at six medical centers participating in the Prevention Epicenter Program of the CDC. Using a standardized form, observers...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/502163
更新日期:2003-12-01 00:00:00
abstract:OBJECTIVE:To study the cost-effectiveness of vaccination for hepatitis A. SETTING:Hypothetical analysis of students currently enrolled in medical school in the United States. METHOD:A Markov-based model was developed using data from the literature, actual hospital costs, and an annual discount rate of 5%. The inciden...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/647513
更新日期:1997-10-01 00:00:00
abstract:OBJECTIVE:To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important. DESIGN:Prospective SSI surveillance with voluntary PDS. Recommended methods for...
journal_title:Infection control and hospital epidemiology
pub_type: 杂志文章
doi:10.1086/506403
更新日期:2006-08-01 00:00:00