Healthcare Executive - September/October 2013 - 70

Improving Patient Care

leaders to analyze the return on
investment for all improvement
efforts.
Studies indicate that the estimated
economic impact of one infection
is approximately $100,000 in hospital costs alone after hip arthroplasty and $60,000 after knee
arthroplasty. This is three to four
times the average cost of the initial
surgery, and these excess costs are
absorbed by hospitals, patients and
payors. Though infections following hip and knee replacement surgery are not currently on the list
of hospital-acquired conditions
denied reimbursement by the
Centers for Medicare & Medicaid
Services, there is an emerging consensus that many of these infections are avoidable, and it is likely
that their costs will increasingly be
borne by providers.
The screening and decolonization
treatment regimen alone has been
shown to reduce the risk of infections due to Staphylococcus aureus by

60 percent compared to control
groups, according to a 2010 article
in the New England Journal of
Medicine by Lonneke Bode, MD,
Jan Kluytmans, MD, phD, Heiman
Wertheim, MD, phD, et al. Though
costs vary by setting, it’s also worth
noting that the associated costs of
implementing the project JOINTS
practices are marginal (see sidebar,
below) compared to the costs of
an infection.

Effective patient education
occurs when clinicians
and patients discuss
together what they can do
jointly to reduce surgical
site infections.
Hospitals can expect administrative and clinical costs associated
with incorporating these practices
into their presurgical and surgical
workflow. However, organizations

Costs of Implementing Project JOINTS Practices
Supplies
Alcohol-containing antiseptic agent

$1 to $4

Chlorhexidine wipes or soap

$5 to $8

Standard culture for Staph
screening

$20 to $50 per Staph test
using culture

Polymerase chain reaction for
Staph screening

$130 to $200 per Staph test
using PCR

Mupirocin

Approximate Cost per Patient

$15

Healthcare Executive
SEpT/OCT 2013

can offset these costs through the
benefits of infection prevention,
decreased readmissions and
decreased lengths of stay. As these
practices increasingly become part
of routine care for other types of
surgery—such as spinal and obstetrical procedures—having these
practices built into the hospital
workflow will lead to considerable
benefits to other service lines.
With a growing number of organizations participating in project
JOINTS reporting they have gone
months without a single hip or
knee SSI, early results would indicate that adding these recommended practices to a hospital’s
workflow has the potential to
accelerate infection prevention
efforts. As the number of hip and
knee arthroplasty procedures quadruples and healthcare organizations face public reporting on
infections, careful attention to
infection reduction for these procedures will be critical to reducing
costs, improving health and
enhancing the patient experience.
Healthcare leaders should be ready
to lead these efforts. s
Anila Hussaini, RN,
is a project manager at
the Institute for
Healthcare Improvement.
She can be reached at
ahussaini@ihi.org. Jeff
Hussaini
Martin is president and
regional CEO at
Ministry Health Care
in Stevens Point, Wis.,
a participant in IHI’s
Project JOINTS initiaMartin
tive. He can be reached at
jeff.martin@ministryhealth.org.

Healthcare Executive - September/October 2013

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