Methods: A decision analysis model was created. Probabilistic costs were determined from published literature and direct observation of pharmacy/microbiology staff. The primary outcome was the expected per-patient cost savings (microbiology, pharmacy, and indirect hospital costs) after initial specimen diversion device (e.g. SteriPath) implementation in the ED using a hospital perspective. Indirect hospital costs included increased hospital length of stay, additional procedures, adverse drug reactions, and hospital-acquired infections. Models were created for hospitals that routinely or do not routinely use rapid diagnostic tests (RDT) on positive blood cultures.
Results: The routine implementation of an initial specimen diversion device for blood culture collection in the ED was cost-beneficial compared to conventional blood culture collection methods and was also associated with a reduction in antibiotic usage, adverse drug reactions and hospital-acquired infections. When implemented in a hospital utilizing RDT with a baseline contamination rate of 6%, initial specimen diversion device use was associated with a cost-savings of $272 (3%) per blood culture in terms of overall hospital costs and $28 (5.4%) in direct-only costs. Main drivers of cost included the baseline rate of contamination in the ED and the duration of antibiotics given to patients with negative blood cultures.
Conclusion: Implementation of an initial specimen diversion device is estimated to be a cost-beneficial strategy to reduce the clinical and economic impact of blood culture contamination in terms of microbiology, pharmacy and wider indirect hospital costs.
K. W. Garey, Merck & Co.: Grant Investigator , Grant recipient .
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