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Patient benefits outweigh gown costs in intensive care unit

Washington University In St Louis : 15 August, 2006  (Technical Article)
Requiring hospital workers and patient families to wear protective gowns when they visit patients with a drug-resistant bacteria provides infection control benefits that significantly outweigh gown costs, according to a new study led by Washington University School of Medicine in St. Louis.
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 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, 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.'

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.'
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