Requiring the gowns added more than $70,000 to an intensive care unit's annual costs, but saved the unit over $400,000 in annual hospital costs associated with potential spread of the bacteria.
The analysis, conducted over two-and-a-half years at the medical intensive care unit (MICU) at Barnes-Jewish Hospital in St. Louis, focused on patients who spent at least 24 hours in the unit and tested positive for vancomycin-resistant Enterococcus (VRE), a drug-resistant bowel organism often picked up by patients during hospital stays.
"Gowns are not cheap, they're not one-size-fits-all, and they can take anywhere from 35 seconds to 95 seconds to put on or take off--and that should be done every single time someone needs to go into a patient's room," says Linda M. Mundy, M.D., senior investigator for the study and associate professor of medicine. "But gowns still appear to provide a net benefit in terms of infection control, at least among intensive care unit patients."
The study will be published in the May 11 issue of Infection Control and Hospital Epidemiology. First author is Laura A. Puzniak, Ph.D., research director at the St. Louis County Health Department. Kathleen Gillespie, Ph.D., an expert in health economics at St. Louis University, led the economic analysis.
Puzniak and Mundy had previously shown that gowns could prevent the spread of VRE in MICU patients. For most patients, VRE is limited to the bowels and causes few symptoms, a condition known as colonization. But in some patients the bacteria becomes an infection by breaking out of the bowel and into the bloodstream, causing a potentially life-threatening condition known as bacteremia.
VRE is a cause for concern among infection-control specialists because it can live for up to eight weeks on hard surfaces such as bedrails or telephone handsets. Scientists also believe VRE can exchange genes with Staphylococcus aureus, which is considered a more serious health threat than VRE. The genetic swap can worsen Staphylococcus by making it more drug resistant.
To calculate the cost of requiring gowns, the team incorporated factors including the prices of gowns, providing isolation carts outside patients' rooms for gowns and other infection-control supplies, testing for infection, and the time doctors and nurses spent putting on and taking off gowns.
As a part of their efforts to estimate potential financial costs of not requiring gowns, the researchers used a new approach called colonization pressure to assess risk of infections spreading among patients. Colonization pressure on a patient is determined by calculating the percentage of patients in a medical unit who have a particular infection. If there are 18 other patients in a medical unit, and six have VRE on a given day, the nineteenth patient's VRE colonization pressure for that day is 6/18 or 33 percent.
Scientists also analyzed infection risks during a 12-month period in the middle of the study when the gowning requirement was removed.
Not factored into the analysis were the societal costs of increased spread of VRE, including missed work days and increased illness and death. All of these factors could increase the benefits provided by the gowns.
Mundy notes that Barnes-Jewish Hospital policy already requires staff and visitors to wear hospital gowns when visiting a patient colonized or infected with drug-resistant bacteria, so instituting a similar policy at other hospitals might require additional costs for initial set-up and staff education.
"Those kinds of costs only would be incurred once, though, while the cost benefits would continue to accrue over time," says Mundy. "Hopefully, our analysis will provide hospital administrators with evidence that gowns might not only be the right thing to do for the patient population, they also might be a cost savings for the hospital."
Puzniak LA, Gillespie KN, Leet T, Kollef M, Mundy LM. A cost-benefit analysis of gown use in controlling vancomycin-resistant Enterococcus transmission: Is it worth the price? Infection Control and Hospital Epidemiology, May 11, 2004.
The full-time and volunteer faculty of Washington University School of Medicine are the physicians and surgeons of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked second in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
Journal
Infection Control and Hospital Epidemiology