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Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program


Contents:

APPENDIX E ó Measuring the Cost of Sharps Injury Prevention


Introduction

One of the processes associated with implementing a sharps injury prevention program is measuring the economic impact of prevention interventions, particularly as the latter contribute to a reduction in sharps injuries. This section discusses various costs that may be attributed to injuries and interventions and provides guidance on how to perform simple calculations that healthcare organizations can use to measure economic impact. These include methods to:

  • Assess the economic impact of injuries on the healthcare organization; and
  • Estimate the cost of implementing various devices with engineered sharps injury prevention features, including any reductions in cost that may be realized as a result of preventing injuries.

Method for Calculating the Cost of Needlesticks/Sharps Injuries

The calculation of needlestick/sharps injury costs described here is viewed from the perspective of direct and indirect costs †incurred by the healthcare organization to manage an exposed healthcare worker. For this reason, several types of costs are ignored. One type is fixed costs that may be associated with a needlestick prevention program, such as surveillance, administration, and building space, as these are not directly related to an individual needlestick event. Also ignored are costs that may be associated with seroconversion. Fortunately, seroconversion after an occupational exposure is a relatively rare event. When it does occur, the healthcare associated costs of treating the healthcare worker are often borne by a third party payer, e.g., workers compensation or a health insurance plan, and not the healthcare organization, although there are exceptions. Costs associated with any legal liability or change in compensation premiums also are not included. There are certain indirect intangible costs that also are not part of this calculation, such as any pain and suffering or societal impact resulting from an exposure or seroconversion. While all of these costs are important aspects of sharps injuries, they are difficult to quantify economically. However, it is important to acknowledge their importance whenever there is any discussion or presentation of information on the cost of sharps injuries in a healthcare organization.

Toolkit Resource for This Activity:

Sample Worksheet for Estimating the Annual and Average Cost of Needlesticks and Other Sharps-Related Injuries (see Appendix E-1)

Direct costs


There are two direct costs that are generally borne by a healthcare organization when a sharp injury occurs. These are:

  • Cost of baseline and follow-up laboratory testing of an exposed healthcare worker and testing the source patient, and
  • Cost of postexposure prophylaxis (PEP) and other treatment that might be provided.

However, if there are complications, such as side effects from PEP, these can add additional costs to managing needlestick injuries. Depending on how workers compensation is arranged, some of these costs may be diverted to a third party payer.† For this reason, it is important to determine what costs are borne by the organization when calculating the cost of a needlestick injury. Individuals in risk management may be able to assist in determining this information.

In certain circumstances, other direct costs may need to be considered. For example, if occupational exposures are managed through a contract with another provider, there may be a fee for each event or visit. Ultimately, any unique costs will need to be determined as part of the process of identifying costs associated with needlestick injuries.

Laboratory Testing Costs†


Laboratory costs should reflect the unit cost to the hospital of each test. If testing is performed outside the facility, the amount that the facility is charged to have the work performed should be used. Laboratory costs include those associated with routine baseline and follow-up antibody testing of exposed employees for HIV, HCV, and HBV.† Antibody testing of employees exposed to HIV is recommended a minimum of three times during the follow-up period, but some organizations follow employees for a year; HCV antibody testing of exposed employees is usually performed once, at four-six months after the exposure.†

In addition to employees, source patients are usually tested for HIV, HCV, and HBV if their serostatus is not know at the time of the exposure. If a facility pays directly for testing a source patient, the cost should be included in the calculation of needlestick costs. However, if such testing is charged to the patient or a third party, this cost is excluded from the cost estimate.

Other laboratory costs are associated with preventing and managing the side effects of postexposure prophylaxis (PEP). These include baseline and follow-up testing to monitor toxicity (e.g., blood count, renal profile, and hepatic profile) and may include pregnancy testing as well.†

Cost of Postexposure Prophylaxis (PEP)

Most of the cost of postexposure drugs will be for HIV PEP. However, there may be times when hepatitis B immune globulin is provided. The cost to the institutionís pharmacy to purchase each drug (not what it would charge a patient) should be the basis for determining cost. For each drug prescribed for PEP, a daily cost (based on the recommended daily dose) should be calculated. If the institution does not have PEP drugs on-site, then charges to the facility from outside pharmacies should be used.†

Costs Associated with† Preventing and PEP Side Effects

The cost of preventing adverse treatment effects generally includes the cost to the facility pharmacy of any antimotility and antiemetic agents prescribed. If prescriptions are filled through an off-site pharmacy, then charges to the facility should be used.

Indirect costs that may be considered

Whenever a sharps injury occurs, time and wages normally associated with assigned responsibilities are diverted to receiving or providing exposure-related care.† These are indirect costs and include:

  • Lost productivity associated with the time required for reporting and receiving initial and follow-up treatment for the exposure;
  • Healthcare provider time to evaluate and treat an employee; and
  • Healthcare provider time to evaluate and test the source patient, including obtaining informed consent for testing if applicable

More than one provider are often involved in managing a single exposure. For example, supervisors may initially assess the exposure and assist in completing the necessary report form; infection control personnel may assess transmission risks and perform other initial and follow-up services; the patientís physician may be called to obtain consent for source testing; and occupational health personnel have administrative and clinical duties associated with the exposure.† For some individuals (e.g., occupational health and infection control), this is part of their job responsibilities and for this reason is not considered a diversion of personnel resources.†

It is not necessary to include diverted time and wages in the calculation of needlestick injury costs. However, it can be an insightful exercise and draws attention to such events in terms of resource utilization. Information is included in the tools provided for performing this calculation.

Approaches to calculating or estimating the average and annual cost of needlestick injuries


Although several discrete costs associated with needlestick injuries have been identified, not all of these costs are incurred with every exposure. For example, if a source patientís serostatus is known, or the patient is unavailable, testing of that individual may not be performed. Likewise, follow-up testing of an employee is generally not performed if the source has no bloodborne virus infection. Furthermore, the need for PEP is based on the nature and severity of the exposure, and not all healthcare workers receive PEP or may only take an initial dose until source testing results are available. Many scenarios can be described.

For many facilities, it may not be possible to determine a cost for each exposure. For this reason, other options for estimating these costs can be used.

  • Calculate the cost of a sample of exposures based on the type of injury (e.g., low, medium, or high risk). That information can be used to identify the range of costs for a single sharp injury and then project the annual cost to the facility based on the number of injuries that occur.
  • Use information on testing and postexposure costs from examples provided in this workbook or other published reports to arrive at a high and low cost of injuries. This information can be used as described above to project the annual cost to the facility for these events.

This can be powerful information for communicating the importance of preventing these injuries to management.

Estimate the cost of injuries associated with specific devices


As leadership teams evaluate which devices with engineered sharps injury prevention features will be considered as priorities for implementation, one factor that can guide decisions is the cost of injuries with certain types of devices. This is a fairly simple calculation that involves listing the number of reported injuries caused by each device in the previous year and multiplying that by the average cost of a needlestick/sharps injury as derived from the previous calculation.

Toolkit Resource for This Activity:

Sample Worksheet for Estimating Device-Specific Percutaneous Injury Costs (see Appendix E-2)

Compare the cost of conventional devices to devices with safety features


This type of economic analysis can help determine how the cost of implementing a device with safety feature might be offset by reductions in injury costs. This type of analysis should be viewed as one of several tools that can be used to inform decisions, but should not be the determining factor in deciding whether to implement devices with safety features or which device(s) to implement.

The following are the two categories of costs that are considered in the calculation of a cost-effectiveness ratio:

  • Projected costs of implementing the prevention intervention, i.e. device with safety feature, and
  • Cost savings resulting from a reduction in needlestick/sharps injuries.

Step 1.†††† Estimate the projected costs associated with purchasing and implementing a device with safety features.

Two values must be determined to make this calculation. The first is the direct purchase cost of both the conventional and replacement device; the other is the indirect cost of implementation, e.g., training, stock rotation. It is not necessary to estimate the indirect costs of implementation. However, when discussing or presenting information on device implementation, these costs should be acknowledged.

A.† Determine the direct cost of purchasing a new device

This calculation is made by determining the difference in unit cost of a conventional device and a comparable device with safety feature (this could result in a cost increase or decrease) and multiplying that figure by the projected yearly purchase volume to arrive at the annual direct cost of implementation (assuming each device cost and number of devices used remains stable).†

B.† Consider the indirect costs associated with implementation


Toolkit Resource for This Activity:

Sample Worksheet for Estimating a Net Implementation Cost for an Engineered Sharps Injury Prevention Device (see Appendix E-3)

This calculation is more complex because it involves identifying the time costs of individuals who are involved in the activities required to implement a new device.† Some organizations may decide not to perform this calculation because of its complexity.† However, identifying these costs can provide considerable insight into the impact of making product changes. Time and wage costs that should be considered include time for:

  • Inventory changeover and replacement of conventional devices with the new devices
  • Training healthcare providers in the use of the new device
  • Pre-selection device evaluation

Organizations may identify other indirect costs associated with making product changes and should include these in this calculation. A total implementation cost is derived by adding the direct and indirect costs (if calculated).

Step 2.†††† Calculate the projected cost savings resulting from a reduction in injuries.

The formula for calculating the projected cost savings resulting from a reduction in injuries after implementation of a device with safety feature is:

(injuries with the conventional device) multiplied by (projected percent reduction in injuries with the device with safety feature) multiplied by the average cost of a needlestick injury to the healthcare facility (as calculated on Toolkit resource† #15).

It is necessary, therefore, to estimate a proportionate reduction in injuries associated with implementation of a particular device. This can be done in two ways.† One is to use published efficacy data on the same or similar device from studies in the literature. The other is to examine institutional data and, based on the injury circumstances, determine what proportion of injuries might be prevented with a new device.

Step 3.†††† Calculate the net implementation cost.

The net implementation cost is the implementation cost minus the cost savings realized through fewer injuries with a device. (If the unit cost of the replacement device is actually less than the unit cost of the conventional device, then the only implementation costs are indirect.)†

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Publish date: February 12, 2004
This page last reviewed February 12, 2004