Using disposable products to prevent cross-contamination is a no-brainer; after all you are protecting your patients and your staff members from infection, while saving your facility thousands of dollars from healthcare-acquired infections (HAIs). However, evaluating and implementing potential disposable products can sometimes be a complex task that has a lot of variables.
First, evaluate the biggest impact of having the product. With stretched budgets and resources how do you allocate your time, energy, and finances to make the largest infection control impact? When it comes to evaluating disposable products here are some factors that will highlight which reusable products have the highest risk of providing cross contamination.
1. Start by looking at products that have the most direct contact to the patients. Products that contact the patient near wounds or surgical sites increase exposure risks.
2. Figure out how many patients does one of these reusable products touch in its lifetime (contamination risk of product to patient)?
3. Figure out how many different units of this reusable product does one patient touch (contamination risk of patient to product)?
4. Ask yourself, how effective is the cleaning of the product?
Second, determine the costs and benefits associated with the product. By preparing the cost justification using the costs and benefits the adoption can make everyone in the facility happy. Let’s look at disposable ECG lead wires. Lead wires are in direct contact with patients, lie near or over surgical sites, are handled by nurses and patients alike and have been shown to be difficult to clean. New disposable lead wires have become available with shielding and the ability to replace the reusable without losing a quality ECG trace. Sounds great, but how are we going to minimize the cost and maximize the return on investment?
There are two types of costs that need to be established, implementation costs, which are based on the product features and the product usage, how it will be used in the hospital. These costs can include installation equipment, staff training and inventory. The best way to reduce these costs is to evaluate new products on their similarity to existing products and procedures. A new product that attaches to a patient just like the reusable product may be favorable over a new system that will require staff training. Additionally, if unique equipment such as adaptor is required for the use of the product, this may be costly to implement or may lock you into one vendor for supply.
Next is usage cost. Usage costs are the costs associated with each patient for the use of the product. In the case of a disposable lead wire, this would be the cost of the product. These costs can be reduced by finding a less expensive product or by changing the usage model use to maximize each products use. For example, if the product can travel with the patient from department to department and last for the entire patient stay, the cost for the product is reduced by not having to use multiple units or sets of the same product.
The benefits (defined as the positive impact in cost savings, patient safety and staff safety) for using a disposable product can be different for each area of the hospital, and for different patient demographics. The largest benefit in cost savings is in the prevention of infections.
Each group of patients and each department should be evaluated to determine the expected benefit from implementing a disposable product. The first step is to identify the real benefit of preventing an infection. This can include the cost of an infection and the safety of the patient and staff. Many hospitals have identified the cost of an infection can be between $50,000 and $90,000 per case. The other factor is how many infections can be saved with the use of the disposable product? In the case of lead wires, clinical data is limited. As more data becomes available, this number will be easier to predict. Based on the findings of a Virginia hospital, disposable ECG lead wires can reduce surgical site infections by 40 percent.1
With limited clinical data, a phased approach can be implemented. First, categorize the infection risk of groups of patients from highest risk to lowest. Example: Burn victims, trauma, open heart, Immune deficiencies, surgical, etc. Once you have done this, develop a product usage plan that will incorporate the top areas first for product implantation. As the benefits are shown in these areas, increase the scope of usage.
Once you have these base components, you can build a cost vs. benefit analysis. Not many facilities are going to adopt a new disposable product with out a clear understanding of the bottom line. First gather the costs. From your usage model calculate how many patients will use the disposable product in a year. Add the implementation costs in the first year.
3,000 patients x $18 per patient = $54,000 per year
Installation costs = $0 first year only
Next calculate the benefits. How many infections per year do you think you will save in the implemented areas? How much does each infection cost?
3 infections saved per year x $60,000 per infection = $180,000 per year in benefit
This cost/benefit analysis is built on the reduction of the number of infections. The expected benefit is based on what we know about the product and infections. In addition, all new initiatives should be tracked to verify the actual results provide the benefits expected.
Lastly, evaluate the risk and reward. Risk and reward can be measured to help understand the exposure that the hospital has to and unsuccessful product adoption. The reward can be shown as a return on investment (ROI). This is calculated by dividing the benefit by the costs; in this case: $180,000 /$54,000 = 3.33 or a return on investment of 333 percent.
OK, so a 333 percent ROI looks pretty attractive, what if things don’t go well? What is the risk of making this investment? This can be answered by determining how long it will take to know if using the product will reduce the number of infections. Since hospital infections are not a daily occurrence, let’s use six months as an evaluation or trial period. If we measure the infection rates for six months we should be able to determine if the infection rate is declining. The cost of those six months is the risk and is calculated by adding three costs: implementation costs, product costs and reimplementation cost (the costs of going back to using a reusable). In this case, implementation costs are $0 and reimplementation costs are $0. (You can keep the reusable cables that you were using and put them back in service to convert back if required). This leaves the cost of the product as the risk or one-half of $54,000 equals $27,000. The risk can also be reduced by using the product in smaller patient demographic groups to start. Once the savings are proven in one area, expand the product use to new areas.
Scott Carter, MBA, is product manager at Curbell Electronics, Inc. and can be reached at firstname.lastname@example.org
1. Barnett T. The not-so-hidden costs of surgical site infections. AORN J. Vol. 86, No. 2. Pages 249-258. August 2007.