title: The Cost of Responding to an Acinetobacter Outbreak in Critically Ill Surgical Patients.
abstract: BACKGROUND
  Our institution had an outbreak of multi-drug-resistant Acinetobacter (MDRA) in 2011. We analyzed the costs of responding to this outbreak from the hospital's perspective.
  
  
  METHODS
  We estimated retrospectively the excess costs associated with an MDRA outbreak response at a major academic medical center, including the costs of staffing, supplies, administrative time, deep cleaning, and environmental testing. Differences in mean costs before and during the 2011 MDRA outbreak were analyzed using the Student t-test.
  
  
  RESULTS
  The overall excess cost incurred during the outbreak response was $371,079 in 2011 U.S. dollars. The largest contributors were the extra resources needed to staff and clean the two intensive care units (ICUs) (78%). In the general surgery ICU, the mean weekly cost of nursing during the outbreak was $13,276 more for regular hours (+15%; p < 0.01) than in the pre-outbreak period and $2,682 more for overtime hours (+86%; p = 0.02). In the trauma ICU, the cost was $20,746 more for regular hours (+24%; p < 0.01) and $3,445 more for overtime hours (+124%; p < 0.01). The costs of supplies ($13,036; +30%; p = 0.03) and gloves ($2,572; +48%; p = 0.01) also were greater during the outbreak. Administrative time, consumables, use of a surge pod, and environmental testing accounted for the remainder of the extra costs.
  
  
  CONCLUSIONS
  Our institution incurred $371,079 in excess costs as a result of an MDRA outbreak. This figure does not include the costs related to treatment of the infections, loss of reimbursement because of hospital-acquired infection, legal services, or changes in staff morale, patient satisfaction, or hospital reputation. Strategies to prevent and control such outbreaks better have substantial value.
authors.affiliation: 1 Department of Health Policy and Management and Center for Health Decision Science, Harvard School of Public Health , Boston, Massachusetts.
authors.forename: Yushan
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: 1 Department of Health Policy and Management and Center for Health Decision Science, Harvard School of Public Health , Boston, Massachusetts.
authors.forename: Stephen
authors.initials: S
authors.lastname: Resch
authors.affiliation: 2 Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School , Boston, Massachusetts.
authors.forename: Xiaoxia
authors.initials: X
authors.lastname: Liu
authors.affiliation: 3 Department of Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania.
authors.forename: Selwyn O
authors.initials: SO
authors.lastname: Rogers
authors.affiliation: 2 Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School , Boston, Massachusetts.
authors.forename: Reza
authors.initials: R
authors.lastname: Askari
authors.affiliation: 4 Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, and Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
authors.affiliation: 5 Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University , Richmond, Virginia.
authors.forename: Sudha P
authors.initials: SP
authors.lastname: Jayaraman
mesh_terms: D000046:Academic Medical Centers; D000150:Acinetobacter / Q000187:drug effects; D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000517:prevention & control*; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D017048:Health Care Costs; D006801:Humans; D017053:Infection Control / Q000191:economics* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies