Humans, 'things' and space: costing hospital infection control interventions

BACKGROUND

Previous attempts at costing infection control programmes have tended to focus on accounting costs rather than economic costs. For studies using economic costs, estimates tend to be quite crude and probably underestimate the true cost. One of the largest costs of any intervention is staff time, but this cost is difficult to quantify and has been largely ignored in previous attempts.

AIM

To design and evaluate the costs of hospital-based infection control interventions or programmes. This article also discusses several issues to consider when costing interventions, and suggests strategies for overcoming these issues.

METHODS

Previous literature and techniques in both health economics and psychology are reviewed and synthesized.

FINDINGS

This article provides a set of generic, transferable costing guidelines. Key principles such as definition of study scope and focus on large costs, as well as pitfalls (e.g. overconfidence and uncertainty), are discussed.

CONCLUSION

These new guidelines can be used by hospital staff and other researchers to cost their infection control programmes and interventions more accurately.

CT diagnosis of acquired intercostal lung herniation

Intercostal lung herniation is a rare complication of trauma, best demonstrated by computed tomography. Most intercostal lung herniations are the result of direct trauma to the chest wall or occur at sites of prior percutaneously placed chest tubes. We present two cases of acquired intercostal lung herniation.

Cholesterol levels in normal Irish adults: the Mater Hospital Cholesterol Screening Survey

Serum samples from 954 Irish adults (604 males, 350 females) aged 18 to 65 years were analyzed within 24 hours of receipt for non-fasting total serum cholesterol levels. The subjects were volunteer blood donors (Blood Transfusion Service Board, Pelican House, Dublin) presenting from June 1990 to February 1991. Serum cholesterol increased significantly with age in both males and females. Mean serum cholesterol in males increased from 4.5 (+/- 0.9) mmol/l in those < 25 years, to 5.7 (+/- 1.0) mmol/l at age 55-64 years. In females, mean serum cholesterol increased from 4.3 (+/- 0.9) mmol/l less than 25 years to 6.2 (+/- 0.8) mmol/l at age 55-64 years. Options for reporting cholesterol ranges are discussed. The overall mean cholesterol concentration of 5.1 mmol/l seen in this study is lower than that reported for comparable studies of U.K. and American subjects, but higher than observed in Japanese individuals. Almost 48% of the studied population had a serum cholesterol value less than 5 mmol/l and over 56% had levels less than 5.2 mmol/l.

Nonpalpable ductal carcinoma in situ versus infiltrating carcinoma of the breast--can they be differentiated by mammography?

The radiologic patterns of 193 consecutive women with nonpalpable breast carcinoma were evaluated. The results were correlated with patient age and with the histopathologic diagnosis. Of the 193 women in the study, 135 (70%) were older than 50 years; 102 women had ductal carcinoma in situ, and 67 (62%) of them were over age 50; the remaining 91 women had infiltrating carcinoma, and 73 (80%) of these patients were older than 50 years. Of the 58% of women who presented with microcalcifications, 75% had ductal carcinoma in situ and 25% infiltrating carcinoma. Of the 36% of patients who presented with a mass, 87% had infiltrating carcinoma and 90% were over age 50. Six percent presented with a mass with microcalcifications; 75% of these masses were found to be infiltrating carcinoma. Most of the masses were infiltrating carcinoma, and of these 90% were high-density masses. The small number of masses representing ductal carcinoma in situ were proportionately of low density.