This article is part of a series of inspiring stories behind the vital work being done to reduce the global burden of this preventable public health challenge. 

Estimating the cost of healthcare-associated infections and the cost-effectiveness of infection prevention strategies is challenging. Most studies estimate the burden of nosocomial infections by looking at the cost of extra days in hospital due to the infection, or costs directly attributable to treatment of the infection – antibiotics or surgery. Estimating the socio-economic impact, however, is far more complex. 

The 1988 SENIC (Study on the Efficacy of Nosocomial Infection Control) project in the United States was a landmark project establishing the importance of infection control. Researchers estimated that 32 percent of nosocomial infections occurring in hospitals without an effective infection control team could be avoided. Key conditions identified were surveillance and control efforts, one infection nurse for 250 beds, the presence of a trained hospital epidemiologist and feedback of surgical wounds infection rates to practicing surgeons.

A recent European study indicated that infection with methicillin-resistant or methicillin-susceptible Staphylococcus aureus (MRSA or MSSA) carries a significant health-economic cost. Bloodstream infection with either of these bacteria is associated with excess length of stay and mortality. In 2007, 27,711 episodes of MRSA were associated with 5,503 excess deaths and 255,683 excess hospital days in participating countries. The total costs attributable to excess hospital stays for MRSA topped $63 million.

Other bacteria are threatening patient safety. Based on prevailing trends, the number of infections caused by third generation cephalosporin resistant E.coli is likely to increase rapidly, outnumbering MRSA infections in the near future.

Another study looking only at patients in European intensive care units (ICU) found healthcare-associated bloodstream infections and pneumonia both increase mortality, while pneumonia increases the length of stay in ICU. By contrast, the additional impact of antimicrobial resistance on these patient outcomes was low. In other words, in the ICU context, infection must be prevented regardless of whether it is due to a resistant bacteria or not.

Some experts have suggested projections regarding the cost of antimicrobial resistance grossly under-estimate the ‘true cost’ by focusing on excess costs of hospitalization. According to Professor Richard Smith from the World Health Organization’s Collaborating Center on Global Change and Health, “the real human cost will be felt when we can no longer treat infections because we have no effective antibiotics.” As antimicrobial resistance spreads worldwide and increasingly affects patients with little buying power, drug companies are reluctant to invest in the development of cheap antibiotics that patients take for a short time, as opposed to drugs treating chronic conditions like arthritis or heart disease.

Andrew Stewardson, Research Fellow at the University of Geneva Hospitals, notes that “in addition to costs associated with healthcare provision and patient health, estimates of the societal impact of antimicrobial resistance should take into account the current trajectory, which leads towards a future with limited access to effective antibiotics.”

On the bright side, a recent German study identified the use of alcohol-based hand-rub and antimicrobial stewardship programs as “positive externalities,” associating hand hygiene and the reduction of antibiotic use with cost saving. Similarly, a recent American study suggested 100,000-200,000 central line-associated bloodstream infections have been prevented since 1990 through the implementation of evidence-based prevention practices.

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Meet the Expert: Principles of Health Economics Applied to Infection Control and Antimicrobial Resistance

ICPIC, 26 June 2013

Keynote Lecture: The Legacy of the SENIC Study, 40 Years Later

ICPIC, 28 June 2013