title: Hand hygiene noncompliance and the cost of hospital-acquired methicillin-resistant Staphylococcus aureus infection.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Keith L
authors.initials: KL
authors.lastname: Cummings
authors.forename: Deverick J
authors.initials: DJ
authors.lastname: Anderson
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000046:Academic Medical Centers; D003428:Cross Infection / Q000191:economics* / Q000382:microbiology / Q000635:transmission; D019983:Guideline Adherence / Q000191:economics*; D006235:Hand Disinfection / Q000379:methods / Q000592:standards*; D006282:Health Personnel / Q000523:psychology*; D017721:Hospital Costs; D006801:Humans; D006920:Hygiene; D017053:Infection Control; D017757:Infectious Disease Transmission, Professional-to-Patient; D055624:Methicillin-Resistant Staphylococcus aureus; D009657:North Carolina; D013203:Staphylococcal Infections / Q000191:economics* / Q000382:microbiology / Q000635:transmission