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October 24, 1990, Vol 264, No. 16 >
ARTICLE | October 24, 1990

The Direct Costs of Universal Precautions in a Teaching Hospital FREE

Bradley N. Doebbeling, MD, MS; Richard P. Wenzel, MD, MSc
[+] Author Affiliations

Reprint requests to Department of Internal Medicine, C-41 GH, The University of Iowa College of Medicine, Iowa City, IA 52242 (Dr Doebbeling).


JAMA. 1990;264(16):2083-2087. doi:10.1001/jama.1990.03450160053028
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References

An analysis of the increase in expenditures for barrier isolation materials before and after the institution of universal precautions at our 900-bed university hospital was used to generate a national estimate of the cost of implementation of the new Centers for Disease Control guidelines. Following the institution of universal precautions, use of rubber gloves at our hospital increased from 1.64 million pairs to 2.81 million pairs annually. A 5-year review of hospital purchasing and supply records in both inpatient and outpatient areas indicated that the total annual costs for isolation materials increased by $350 900. This represented an increase from $13.70 to $22.89 per admission (60%) after adjustment for inflation. The cost of isolation materials increased from $98 to $215 per 1000 outpatient visits, an adjusted increase of 92%. Two thirds of the increase (64%) was due to rubber gloves and an additional 25% was due to disposable isolation gowns. Universal precautions are estimated to have cost at least $336 million in the United States in fiscal year 1989 after adjustment for inflation. If expenditures for isolation materials at our medical center are representative, previous estimates may have significantly underestimated costs nationwide.

(JAMA. 1990;264:2083-2087)

REFERENCES

1 +
Centers for Disease Control.  Recommendations for prevention of HIV transmission in health care settings . MMWR . 1987;;36( (suppl) ):35-185.
2 +
Taylor T.  Shortages of medical gloves eases: FDA to check quality . Health Week . (March 6) , 1989;:13,32.
3 +
Centers for Disease Control.  Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings . MMWR . 1988;;37:377-387.
4 +
Broderick A, Mori M, Nettleman MD, Streed SA, Wenzel RP.  Nosocomial infections: validation of surveillance and computer modeling to identify patients at risk . Am J Epidemiol. 1990;;131:734-742.
5 +
Garner JS, Simmons BP.  CDC guidelines for the prevention and control of nosocomial infections: guideline for isolation precautions in hospitals . Am J Infect Control . 1984;;12:103-166.
6 +
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM.  CDC definitions for infections, 1988 . Am J Infect Control . 1988;;16:128-140.
7 +
CPI Detailed Report: Consumer Price Index— US City Average . Washington, DC: Bureau of Labor Statistics, US Dept of Labor; 1989;.
8 +
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research: Principles and Quantitative Methods . Belmont, Calif: Lifetime Learning Publications; 1982;:285-302.
9 +
Hospital Statistics: 1989-90 Edition . Chicago, Ill: American Hospital Association; 1989;.
10 +
Occupational Safety and Health Administration.  Occupational exposure to bloodborne pathogens . Federal Register . (May 30) , 1989;;54:23 042-23139.
11 +
Weinstein S.  OSHA underestimates cost of law on bloodborne pathogens . Hosp Infect Control . 1989;;16:133-136.
12 +
Rettig PC.  OSHA's proposal ignores the CDC's guidelines . Health Facil Manage . (November) 1989;;2:39-41.
13 +
McPherson DC, Jackson MM, Rogers JC.  Evaluating the cost of the Body Substance Isolation System . J Healthcare Mater Manage . (August) -September 1988;;6:20-28.
14 +
Miller PJ, Farr BM.  A survey of SHEA members on universal precautions and HIV screening . Infect Control Hosp Epidemiol. 1988;;4:163-165.
15 +
Gordin FM, Gilgert C, Hawley HP, Willoughby A.  Prevalence of human immunodeficiency virus and hepatitis B virus in unselected hospital admissions: Implications for mandatory testing and universal precautions . J Infect Dis. 1990;;161:14-17.
16 +
Mitchell R, Cumming CG, MacLennan WD, Ross PW, Peutherer JF, Baxter PM.  The use of operating gloves in dental practice . Br Dent J. 1983;;154:372-374.
17 +
Doebbeling BN, Pfaller MA, Houston AK, Wenzel RP.  Removal of nosocomial pathogens from the contaminated glove: implications for glove reuse and handwashing . Ann Intern Med. 1988;;109: 394-398.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Centers for Disease Control.  Recommendations for prevention of HIV transmission in health care settings . MMWR . 1987;;36( (suppl) ):35-185.
2 +
Taylor T.  Shortages of medical gloves eases: FDA to check quality . Health Week . (March 6) , 1989;:13,32.
3 +
Centers for Disease Control.  Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings . MMWR . 1988;;37:377-387.
4 +
Broderick A, Mori M, Nettleman MD, Streed SA, Wenzel RP.  Nosocomial infections: validation of surveillance and computer modeling to identify patients at risk . Am J Epidemiol. 1990;;131:734-742.
5 +
Garner JS, Simmons BP.  CDC guidelines for the prevention and control of nosocomial infections: guideline for isolation precautions in hospitals . Am J Infect Control . 1984;;12:103-166.
6 +
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM.  CDC definitions for infections, 1988 . Am J Infect Control . 1988;;16:128-140.
7 +
CPI Detailed Report: Consumer Price Index— US City Average . Washington, DC: Bureau of Labor Statistics, US Dept of Labor; 1989;.
8 +
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research: Principles and Quantitative Methods . Belmont, Calif: Lifetime Learning Publications; 1982;:285-302.
9 +
Hospital Statistics: 1989-90 Edition . Chicago, Ill: American Hospital Association; 1989;.
10 +
Occupational Safety and Health Administration.  Occupational exposure to bloodborne pathogens . Federal Register . (May 30) , 1989;;54:23 042-23139.
11 +
Weinstein S.  OSHA underestimates cost of law on bloodborne pathogens . Hosp Infect Control . 1989;;16:133-136.
12 +
Rettig PC.  OSHA's proposal ignores the CDC's guidelines . Health Facil Manage . (November) 1989;;2:39-41.
13 +
McPherson DC, Jackson MM, Rogers JC.  Evaluating the cost of the Body Substance Isolation System . J Healthcare Mater Manage . (August) -September 1988;;6:20-28.
14 +
Miller PJ, Farr BM.  A survey of SHEA members on universal precautions and HIV screening . Infect Control Hosp Epidemiol. 1988;;4:163-165.
15 +
Gordin FM, Gilgert C, Hawley HP, Willoughby A.  Prevalence of human immunodeficiency virus and hepatitis B virus in unselected hospital admissions: Implications for mandatory testing and universal precautions . J Infect Dis. 1990;;161:14-17.
16 +
Mitchell R, Cumming CG, MacLennan WD, Ross PW, Peutherer JF, Baxter PM.  The use of operating gloves in dental practice . Br Dent J. 1983;;154:372-374.
17 +
Doebbeling BN, Pfaller MA, Houston AK, Wenzel RP.  Removal of nosocomial pathogens from the contaminated glove: implications for glove reuse and handwashing . Ann Intern Med. 1988;;109: 394-398.

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