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Optimal Design of Paired Built Environment Interventions for Control of MDROs in Acute Care and Community Hospitals
Marietta M Squire1, Gareth K Sessel2, Gary Lin3
1Department of Civil and Systems Engineering, 1466Johns Hopkins University, Baltimore, MD, USA.
Objectives:
Our goal was to optimize infection control of paired environmental control interventions within hospitals to reduce methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant Enterococci (VRE).
Background:
The most widely used infection control interventions are deployment of handwashing (HW) stations, control of relative humidity (RH), and negative pressure (NP) treatment rooms. Direct costs of multidrug-resistant organism (MDRO) infections are typically not included in the design of such interventions.
Methods:
We examined the effectiveness of pairing HW with RH and HW with NP. We used the following three data sets: A meta-analysis of progression rates from uncolonized to colonized to infected, 6 years of MDRO treatment costs from 400 hospitals, and 8 years of MDRO incidence rates at nine army hospitals. We used these data as inputs into an Infection De-Escalation Model with varying budgets to obtain optimal intervention designs. We then computed the infection and prevention rates and cost savings resulting from these designs.
Results:
The average direct cost of an MDRO infection was $3,289, $1,535, and $1,067 for MRSA, CRE, and VRE. The mean annual incidence rates per facility were 0.39%, 0.034%, and 0.011% for MRSA, CRE, and VRE. After applying the cost-minimizing intervention pair to each scenario, the percentage reductions in infections (and annual direct cost savings) in large, community, and small acute care hospitals were 69% ($1.5 million), 73% ($631K), 60% ($118K) for MRSA, 52% ($460.5K), 58% ($203K), 50% ($37K) for CRE, and 0%, 0%, and 50% ($12.8K) for VRE.
Conclusion:
The application of this Infection De-Escalation Model can guide cost-effective decision making in hospital built environment design to improve control of MDRO infections.
Insights
Optimizing hospital environmental controls like handwashing stations and negative pressure rooms significantly reduces multidrug-resistant organism infections, saving millions in healthcare costs. This model guides cost-effective infection control strategies.
Area of Science:
- Infection Control and Hospital Epidemiology
- Environmental Health Engineering
- Health Economics
Background:
- Multidrug-resistant organisms (MDROs) like MRSA, CRE, and VRE pose significant threats in healthcare settings.
- Current infection control interventions, including handwashing (HW), relative humidity (RH) control, and negative pressure (NP) rooms, are widely used but their cost-effectiveness in reducing MDROs is not fully optimized.
- Direct costs associated with MDRO infections are often excluded from the design of environmental control interventions.
Purpose of the Study:
- To optimize paired environmental control interventions for reducing infections caused by methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant Enterococci (VRE).
- To evaluate the cost-effectiveness of combining handwashing stations with either relative humidity control or negative pressure treatment rooms.
- To develop an Infection De-Escalation Model for guiding budget-informed intervention design.
Main Methods:
- Examined the effectiveness of pairing HW with RH and HW with NP interventions.
- Utilized a meta-analysis of progression rates from uncolonized to infected states.
- Incorporated 6 years of MDRO treatment costs from 400 hospitals and 8 years of MDRO incidence rates from nine army hospitals into the Infection De-Escalation Model.
- Calculated infection and prevention rates and cost savings based on optimal intervention designs.
Main Results:
- The average direct costs per MDRO infection were $3,289 (MRSA), $1,535 (CRE), and $1,067 (VRE).
- Optimal intervention pairing achieved significant percentage reductions in infections across different hospital types: MRSA (60-73%), CRE (50-58%), and VRE (0-50%).
- Substantial annual direct cost savings were projected, ranging from $118K to $1.5 million for MRSA, $37K to $460.5K for CRE, and up to $12.8K for VRE.
Conclusions:
- The Infection De-Escalation Model provides a framework for cost-effective decision-making in hospital environmental design.
- Optimized environmental control interventions can significantly reduce MDRO infections and associated healthcare costs.
- Implementing evidence-based, cost-optimized infection control strategies is crucial for improving patient safety and hospital resource management.
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