The costs and benefits of controlling vancomycin-resistant enterococci in an Australian teaching hospital

Abstract

The control of antibiotic-resistant nosocomial pathogens places a significant burden on the hospital budget, and hospital administrators need to be convinced of the benefits of infection control programs if they are to provide adequate resources. This paper describes the recent experience of an outbreak of vancomycin-resistant enterococcus (VRE) colonisation among haematology patients in a large tertiary teaching hospital and identifies the costs and benefits associated with control of the outbreak. The largest cost was found to be that associated with the additional nursing requirements, which varied significantly according to where the patient was situated. Other costs identified included those associated with supplies for implementing additional precautions, microbiological screening for VRE carriage and the time involved in developing policies and protocols and staff education. One of the major benefits identified from eliminating VRE carriage is the reduction in nursing costs associated with the implementation of strict isolation precautions. Other benefits include a reduction in the risk of serious, untreatable infection, a reduced theoretical risk of transfer of vancomycin resistance to Staphylococcus aureus and a reduction in patient and public anxiety about VRE. The latter is often not identified as a benefit, since it is difficult to quantify in monetary terms. In addition, a review of antibiotic prescribing guidelines for haematology patients led to a significant cost saving.