الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Surgical site infection presents a substantial problem for patients as well as healthcare providers. Infection of surgical wound causes not only anxiety and discomfort but complicates illness and delays recovery as well. Furthermore, the impact of SSIs can be severe and life-threatening. They may be associated with other HAIs, leading to sepsis and multiple organ failure. Economically, these infections result in additional cost to the healthcare sector, patients and those who care for them.
The aim of this study was to estimate the cost of healthcare-acquired surgical site infection (HA-SSI) in the MRI hospital from patient and hospital perspectives and to show how they are distributed between in-hospital and post-discharge phases of care. Five major steps were taken to estimate this cost.
The first step was to determine the incidence rate of SSI among inpatients as compared to SSI after discharge. This revealed an overall incidence rate for inpatients as 1.1% (95% CI =0.4%, 2.8%). Regardless of the operative category, IR (inpatient) of inpatients with risk index score “2” was 7.1% (95 %CI=1.2%, 31.5%), 1.3% (95 %CI=0.4%, 3.7%) in patients with risk index score of “1” and zero in patients with risk index score of “M” (95% CI= 0%, 8.02%) and “1”(95%CI=0%,5.2%).
The incidence rate of PD SSI detected in the OPC was 12.3% (n=32); 97% (n=31) of SSI-patients developed the infection after hospital discharge. It was the highest among patients with risk index of “2” (30.7%, 95%CI 12.7,57.6), followed by that among patients with risk index of “1” (12.9%, 95%CI 6.7, 23.4) and “0” (10.5%, 95%CI 7.0,15.5). The least incidence rate was observed where no risk factors were present and the operative procedure was performed with a laparoscope (5%, 95%CI 1.2, and 16.5).
The median length of postoperative stay was 1 day ranging from 0 to 15 days. SSI was diagnosed within 7days (SD=4) after surgery.
The second step was identifying and quantifying the resources utilized for care of the SSI inpatients and outpatients. In addition to drugs and consumables, there were nine medical services were used to manage SSI in the MRI hospital namely; wound care in the OPC, inpatient bed day, pre-operative assessment &operative procedure, chest X-ray imaging, U/S abdominal examination, CBC, INR, C&S test and routine biochemical tests.
The third step was estimation of the TDV cost for the 9 services delivered in the MRI hospital to manage SSI were estimated using combined top-down and bottom-up approaches. The TDV cost for wound care in the OPC was EGP11.9 for clean wound and 22.8 for infected wound. It was EGP 40 for inpatient day, EGP 85.2 for pre-operative assessment, EGP 566 for wound debridement and closure in the operative theater, EGP 57 for chest x-ray imaging, EGP 15 for abdominal ultrasound examination, EGP 5 for CBC, EGP 10 for INR, and EGP 35 for C&S test and EGP 10.4 for biochemical tests.
The forth step was calculation of the DVC of SSI borne by the patient and by the MRI hospital for the 32 SSI-patient treated at the MRI hospital using quantities of different services measured from the second step and their estimated costs from the third step. The direct cost paid for managing the thirty-two SSI-patients was EGP 40,328. Patient themselves incurred EGP 26,510(66% of the total cost), while the MRI hospital incurred EGP 13,818 (34% of the total cost).
Finally, a quantitative model was developed to estimate the cost of SSI. It was informed with data collected from the prospective cohort of surgical patients who sought medical treatment in the MRI hospital. A logical model structure was specified and data applied to model parameters. A hypothetical cohort of 1,000 surgical patients was evaluated. Nearly 123 cases would develop SSI and would seek treatment within the MRI hospital. The median total cost of treating them would be approximately EGP 16,248 from the hospital perspective, EGP 41,508 from the patient perspective and EGP 63,063 from both perspectives. The expected probabilities for selected monetary values were estimated as well. For example, the probability that the MRI hospital would bear more than EGP 30,000 in managing SSI, resulted from treating 1,000 surgical patients, is around 30%. Similarly, the probability that around 123 SSI-patients would bear more than EGP 50,000 is 45.4%.
Most of the costs incurred by the hospital sector arose from variable costs and a small proportion arose from lost bed-days. These results could be useful in cost-effectiveness analyses and evaluating the efficiency of infection control programs in reducing the risk of surgical site infection.
In conclusion, nearly 12 out of every 100 surgical patients operated in the MRI developed SSI within 7 days after hospital discharge. They developed deep infection more often than superficial one. They sought treatment at the OPC in the MRI hospital where care and dressing for their infected wound were done. They were usually prescribed oral antibiotics and their wounds healed within 20 days. In 75% of SSI-patients, the cost of their treatment from the MRI hospital perspective did not exceed EGP 230. However, he may bear up to EGP 6,520. Patients themselves incurred about 66% of the total cost, while the MRI hospital incurred only one third of the total costs. Sixty per cent of the costs, tolerated by the MRI hospital, were due to consumables. Thus, they could be theoretically totally saved if all these SSIs had been successfully prevented. The remaining forty per cent was a monetary estimate of the staff times spent on managing those patients and could be efficiently allocated to other activities if their wounds had not been infected. from the cohort of 1,000 surgical patients, around 123 cases would develop SSI and sought treatment within the MRI hospital. The median total cost of treating them would be around EGP 16,248 from the hospital perspective, EGP 41,508 from the patient perspective