Implementing standardized criteria for multi-drug-resistant organisms: a retrospective cost-avoidance analysis for discontinuing contact precautions for ESBL

TL;DR

This study estimates cost savings from using criteria to discontinue contact precautions for certain drug-resistant bacteria in hospitals.

Contribution

The study introduces a cost-avoidance framework for discontinuing contact precautions for non-MDRO ESBL isolates.

Findings

73% of ESBL isolates did not meet MDRO criteria for contact precautions.

Discontinuing precautions for these cases could save $118,209 over four years.

Average daily PPE cost for contact isolation was $40.18.

Abstract

This manuscript calculates the estimated cost-savings associated with implementing criteria for multi-drug-resistant organisms (MDRO).

The study evaluated extended-spectrum beta-lactamase (ESBL) producing Enterobacterales isolates utilizing the MDRO criteria established by Infection Prevention and Control. Isolates were categorized as either meeting or not meeting criteria. The number of inpatient days for patients with isolates not meeting criteria was calculated. The average daily cost of personal protective equipment (PPE) for patients in contact isolation was determined via literature review. Annual cost savings were determined by multiplying the total number of inpatient days by the average cost of PPE per day. Because our institution only isolates patients who meet the MDRO criteria, this approach was considered a cost-saving measure.

560 licensed bed, tertiary care facility in the United States.

Adult inpatients between the years of 2019–2022 with an ESBL-producing Enterobacterales isolated from any specimen source.

229 patients met inclusion criteria. 73% of isolates did not meet MDRO criteria. The patients with ESBL isolates not meeting criteria represented 2942 isolation days over four years. The average cost of PPE for contact isolation per day was $40.18. Cost-savings were estimated at $118,209 over four years.

Our findings provide support for other healthcare systems to define organisms that warrant transmission-based contact precautions.

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