Utilizing a Business Case to Link Reduction in Infections to Reduction in?Costs

Abstract

BACKGROUND A review of literature indicates that expanding chlorhexidine gluconate (CHG) bathing beyond those at high risk to all patients can reduce hospital-acquired infection (HAI) rates. However, infection prevention strategies are often viewed as soft costs and difficult to fund despite HAI prevention being associated with significant cost avoidance. METHODS In February 2017 a task force was assembled to assess risk mitigation. A return on investment (ROI) was compiled for leadership highlighting the potential cost benefit of decreasing Central Line Associated Bloodstream Infections (CLABSI), Catheter Associated Urinary Tract Infections (CAUTI), Methicillin-Resistant Staphylococcus aureus (MRSA) bacteremia and Clostridium Difficile HAIs by expanding CHG use. We calculated the total cost of HAIs from 2016, including Centers for Medicare and Medicaid Hospital Acquired Condition Reduction Program (CMS HACRP) penalty (fiscal year 2017) [100% attribution to HAIs], direct cost and cost impact of HAI reduction using CHG bathing in current high risk populations and projected reductions and cost savings based on literature reviews and applied to all patients house-wide. On April 4, 2017 house-wide CHG bathing for all patients was implemented. Intensive staff education was provided with both face-to-face and electronic educational sessions with reinforcement at the annual employee quality fair. Compliance was measured by routine audits (chart reviews, unit rounds and staff feedback). RESULTS House-wide CHG bathing realized a CLABSI reduction of 65%. With a $17,445 direct cost per CLABSI, our total cost impact of reduction for this HAI was $226,785. Other infection decreases attributed to CHG bathing ranged from 28%-30%, raising the cost impact of HAI reduction to $439,803. CHG bathing costs totaled $40,114.10. CONCLUSIONS Identifying and quantifying the costs and benefits attributable to reduced HAIs at the facility level allows Infection Preventionists to present a business case necessary to justify program initiatives and drive improvement.