Surgical Site Infection Rates in Four Cities in Brazil: Findings of the International Nosocomial Infection Control Consortium

Objective.To present a hypothetical model of the change in economic costs and health benefits to society that result from nosocomial infection control programs.Design.We use a modeling framework to represent how 2 types of costs change with nosocomial infection control programs: costs incurred by the hospital sector and community health services, as well as the private costs to patients. We also demonstrate how to value the health benefits of nosocomial infection control programs, using quality-adjusted life years.Setting.Hypothetical modeling to incorporate the societal perspective.Subjects.A cohort of 50,000 simulated patients at risk of surgical site infection following total hip replacement.Intervention(s).A total of 8 hypothetical interventions that change costs and health outcomes among the cohort by preventing cases of surgical site infection following total hip replacement.Results and Conclusions.We demonstrate that when infection control interventions reduce economic costs and increase health benefits, they should be adopted without further question. If, however, interventions increase economic costs and increase health benefits, then the trade—off between costs and benefits should be examined. Decision-makers should assess the cost per unit of health benefit from infection control programs, consider the impact on health budgets, and compare infection control with alternative uses of scarce healthcare resources.

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French National Program for Prevention of Healthcare-Associated Infections and Antimicrobial Resistance, 1992–2008: Positive Trends, But Perseverance Needed

Infection Control and Hospital Epidemiology ◽

10.1086/598682 ◽

2009 ◽

Vol 30 (8) ◽

pp. 737-745 ◽

Cited By ~ 53

Author(s):

Jean Carlet ◽

Pascal Astagneau ◽

Christian Brun-Buisson ◽

Bruno Coignard ◽

Valérie Salomon ◽

...

Keyword(s):

Antibiotic Resistance ◽

Infection Control ◽

Surgical Site Infection ◽

Second Phase ◽

Healthcare Associated Infections ◽

Site Infection ◽

National Program ◽

Infection Rates ◽

Process Indicators ◽

Healthcare Associated

Objective.To describe the French program for the prevention of healthcare-associated infections and antibiotic resistance and provide results for some of the indicators available to evaluate the program. In addition to structures and process indicators, the 2 outcome indicators selected were the rate of surgical site infection and the proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates among the S. aureus isolates recovered.Design.Descriptive study of the evolution of the national structures for control of healthcare-associated infections since 1992. Through national surveillance networks, process indicators were available from 1993 to 2006, surgical site infection rates were available from 1999 to 2005, and prevalence rates for MRSA infection were available from 2001 to 2007.Results.A comprehensive national program has gradually been set up in France during the period from 1993 to 2004, which included strengthening of organized infection control activities at the local, regional, and national levels and developing large networks for surveillance of specific infections and antibiotic resistance. These achievements were complemented by instituting mandatory notification for unusual nosocomial events, especially outbreaks. The second phase of the program involved the implementation of 5 national quality indicators with public reporting. Surgical site infection rates decreased by 25% over a 6-year period. In France, the median proportion of MRSA among S. aureus isolates recovered from patients with bacteremia decreased from 33.4% to 25.7% during the period from 2001 to 2007, whereas this proportion increased in many other European countries.Conclusions.Very few national programs have been evaluated since the Study on the Efficacy of Nosocomial Infection Control. Although continuing efforts are required, the French program appears to have been effective at reducing infection rates.

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