Counting the cost of contact precautions

A Swiss study has found that the mean cost of a contact precautions day is £130. This is useful in helping us to understand the financial impact of infection prevention and HCAI.

The team directly observed the delivery of 24 hours of contact precautions in 10 patients in a non-outbreak setting. The materials used and extra time associated with contact precautions were logged in four categories: isolation materials, extra cleaning and disinfection materials, staff time, and one-off items (items that did not occur every day e.g. terminal disinfection and curtain changes). (I think it would have been simpler to do this in two categories: materials and labour.) The daily cost was found to be £130 (95% CI £100-156).

Figure: The daily cost of contact precautions. Red = materials, Blue = staff time, Purple = one-off costs (e.g. terminal disinfection).

We went through a similar exercise to count the cost of contact precautions when calculating the cost of a CPE outbreak. There are a couple of costs that we included but the Swiss did not. We calculated the additional cost of an infectious waste stream (compared with a regular waste stream) at £0.33 per isolation day; although the Swiss study included the cost of isolation waste bags, I can’t see that they included the cost of processing the waste itself. We had a policy in place to dispose of unused packaged supplies stocked in the room or bed space of patients on contact precautions. This ‘one-off’ cost amounted to £14 per isolation bed day. So, the cost of a contact precautions day could be even higher if these policies are in place in your hospital.

Overall, our estimate of the cost of a contact precautions day was considerably lower – at £48 per isolation day. The key reason for the vast difference between these figures is the estimation of staff time directly attributable to contact precautions. We performed an informal audit of the staff time attributed to contact precautions and concluded that it was negligible (mainly because staff multitasked whilst donning and doffing gloves and gowns). However, the Swiss concluded that almost exactly 2 hours of staff time per day was attributed directly to the delivery of contact precautions. Since the Swiss audit was performed so carefully, I believe their estimate rather than our ‘quick and dirty’ audit. This means that the true cost of contact precautions in our study was probably closer to £250,000 (rather than the £90,000 included in the study). Staff time is very much a opportunity cost though: these are staff that are already employed full time, so there’s no change to the hospitals bottom line if they spend a few minutes extra each day on delivering contact precautions (but it does mean something else doesn’t get done…!).

I commend the approach of this research team to observe practice so carefully in order to give us the most accurate estimate of the cost of contact precautions yet.

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