Impact of Nosocomial Infections in Argentina: Net Cost Associated with Implementing Effective Infection Control Programs

Background: Nosocomial infections (NI) represent serious, often preventable, and improperly recognized events by health administrators, due to the lack of information that allows evaluating the impact at the national level. This information should be estimated through paired case-control studies to adjust possible confounders. There is little information on effectiveness and cost structure of effective infection control programs (EICP) resulting essential to determine the efficiency of such strategies. With the purpose to determine the impact of NIs and the net cost of an EICP we review local information available.

Objective: To determine the impact of NIs associated to extra inpatient days, mortality and costs, as well as the net cost related to the implementation of an EICP.

Methods: Local data from multicenter prospective (IRIQ and VALIDAR Projects) and prevalence (VIDHA Program) studies were reviewed in order to estimate the overall NI rate. The attributable impact of NIs was estimated from local paired case-control studies. The provider perspective was considered and costs reported in US dollar adjusted to 2007 year present value. Inpatient-days and population projection were estimated from social security system and from the National Institute of Census and Statistics, respectively. The effectiveness of EICPs was estimated from prospective studies by comparing NIs rates from institutions with and without EICPs according to SENIC Project criteria. The cost of a standard EICP was estimated using a 100 hospital-bed as case-base. These data were used to calculate the net cost of EICP (net cost = cost of EICP – cost of NIs avoided).

Results: An overall incidence of 15.25 NI per 1000 inpatient-days was estimated, with an average of 6.42 extra inpatient-days, 11.5% attributable mortality and $1,011 associated costs per NI. For a population of 39,356,383 residents with an annual rate of 417 inpatient-days per 1000 inhabitants, we have estimated 250,097 events of NI per year, representing an annual impact of 1.606.095 extra-inpatient days, and 28,739 attributable deaths, with an associated cost of $252,805,427 (representing 2.3% of the total annual health cost vs. 0.3% in the US). These data places NIs at 4^th place among the leading causes of death in our country. Using an average effectiveness of 20% for EICP, it was estimated annual savings of 320,341 days of hospitalization, 49,706 NIs (5,806 fatal events) and $50,244,442. Taking into account an average annual cost of $62,763 for infection control program per 100 hospital beds, the net cost of EICP proved to be $–22,041,143.

Conclusions: Estimated data shows that the NIs continue representing a serious health problem in our country, with a high impact on overall mortality. The implementation of EICPs can reduce in at least 20% the NI rates resulting in significant net savings, amount that could be greater if social perspective is considered.