Hand hygiene noncompliance and the cost of hospital-acquired methicillin-resistant Staphylococcus aureus infection

BACKGROUND. Hand hygiene noncompliance is a major cause of nosocomial infection. Nosocomial infection cost data exist, but the effect of hand hygiene noncompliance is unknown. OBJECTIVE. To estimate methicillin-resistant Staphylococcus aureus (MRSA)-related cost of an incident of hand hygiene noncompliance by a healthcare worker during patient care. DESIGN. Two models were created to simulate sequential patient contacts by a hand hygiene-noncompliant healthcare worker. Model 1 involved encounters with patients of unknown MRSA status. Model 2 involved an encounter with an MRSA-colonized patient followed by an encounter with a patient of unknown MRSA status. The probability of new MRSA infection for the second patient was calculated using published data. A simulation of 1 million noncompliant events was performed. Total costs of resulting infections were aggregated and amortized over all events. SETTING. Duke University Medical Center, a 750-bed tertiary medical center in Durham, North Carolina. RESULTS. Model 1 was associated with 42 MRSA infections (infection rate, 0.0042%). Mean infection cost was $47, 092 (95% confidence interval [CI], $26, 040-$68, 146); mean cost per noncompliant event was $1.98 (95% CI, $0.91- $3.04). Model 2 was associated with 980 MRSA infections (0.098%). Mean infection cost was $53, 598 (95% CI, $50, 098-$57, 097); mean cost per noncompliant event was $52.53 (95% CI, $47.73- $57.32). A 200-bed hospital incurs $1, 779, 283 in annual MRSA infection-related expenses attributable to hand hygiene noncompliance. A 1.0% increase in hand hygiene compliance resulted in annual savings of $39, 650 to a 200-bed hospital. CONCLUSIONS. Hand hygiene noncompliance is associated with significant attributable hospital costs. Minimal improvements in compliance lead to substantial savings.