Clinical Significance
Threats from Zoonotic Diseases and Drug-Resistant Bacteria
With economic globalization and growing diversity in human demographics, aided by increased efficiencies in air-travel and transportation, the spread of infectious diseases in a society has been accelerated. Our experience with the SARS outbreak highlighted how index patients with severe infections tend to present to hospitals. Because hospitals often bring index patients and vulnerable hosts into a context with intensive anti-microbial use, hospitals may therefore become an important frontline in the spread of both emerging infectious diseases such as SARS as well as multi-drug resistant pathogens like MRSA and VRE.
During outbreaks of emerging infections, hospitals will face the combined stresses of managing excessive admissions and isolation bed requirements while dealing with the control of nosocomial infections. In addition, a highly infectious disease such as influenza is likely also to lead to increased staff absenteeism since staff are liable to be infected both from nosocomial as well as community exposures.
Since the last SARS outbreak in 2003, Singapore has developed and trained its healthcare professionals to use a number of intervention measures such as wearing of N95 masks, washing of hands, quarantining procedures to name a few; we have also explored the utility of stockpiling of antiviral agents for use in treatment and prophylaxis for a possible influenza pandemic. However, it remains unclear what combination of measures will be most effective and efficient; measures such as quarantine and restriction of movements, thought to be helpful in controlling the previous SARS outbreak in the community may not be applicable or efficiently deployable in the hospital setting.
Some Statistics on HAIs and its Costs
6% of Hospital Acquired Infections (HAIs) result in death in the US in 20071. Each HAI represents a 51% increase in procedure cost and the average length of stay increases by 54% for each HAI in the US2. 1600 cases died of HAIs in the UK in 2005 while morbidity figures for HAIs were not available for Singapore hospitals3. The UK Government is expected to spend ₤140 million to manage the outbreak of C.difficile which had caused 90 out of 345 cases of deaths in hospitals between 2004 and 20064.
In Singapore, 3.2 to 4 in 1000 contracted HAI for the public hospitals, with 0.7 to 1.6 in 1000 contracted HAI in hospitals not treating severely ill patients3. Average in-patient rate is 96.3 per 1000 people (in 2006)5. Bill size for class A ward for a public hospital is between S$3400 to S$56006. If each HAI costs an additional 51%, this would mean an increase in healthcare costs from S$1,575,000 to S$2,378,000 or about S$803,000 per 1000 people (or about S$8000 per person).
