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AIDS: the cost of universal precautions.

AIDS: The cost of universal precautions Although the benefits of universal precautions in preventing HIV transmission are significant, the cost of implementing the CDC guidelines comes high.

At recent major study at a 900-bed teaching hospital showed that the cost of barrier isolation materials increased by $350,900 annually after the adoption of universal precautions in 1987. (1) For inpatients, the cost of isolation materials rose from $13.70 to $22.89 per admission, a 60% increase after adjustment for inflation. For outpatients, the cost jumped from $98 to $188 per 1,000 outpatient visits, an increase of 92%.

The detailed study was conducted at the University of Iowa Hospital and Clinics, Iowa City a facility with approximately 33,700 inpatient admissions and 400,000 outpatient visits annually. The authors of the study, Doebbeling and Wenzel, reviewed the hospital's purchasing and supply records for five years, from July 1, 1984, through June 30, 1989, and tabulated expenditures for all isolation materials. These were defined to include latex and vinyl gloves, protective gowns, disposable face masks, reusable pocket masks, protective eyewear, and disposable sharps containers.

The authors made special efforts to adjust for variables, such as the annual inflation of the costs of medical supplies, the yearly infection rates, the number of hospital admissions, the number of surgical and diagnostic procedures, and the proportion of patients with isolation precautions.

In the two years after the University of Iwoa adopted universal precautions in August 1987, use of rubber gloves increased from 1.64 million pairs to 2.81 million pairs annually. The use of disposaable sharps containers increased from 10,300 to 25,600 over the same period. Disposable gown use increased from 83,600 in 1987 by an average of 4,000 gowns annually since.

In fiscal 1987, before universal precautions, the institution's total expenditure for all isolation materials was $509.500. This rose to $860,400 in 1989, an increase of $350,900. Adjusted for inflation, the real increase was $306,600.

The distribution of the increased expenditure for isolation materials remained relatively constant over the two years since universal precautions. Examination gloves accounted for 34% of the increase; surgical gloves, also 34%; disposable gowns, 25%; disposable sharps containers, 7%; and disposable face masks, nearly 2%. Direct costs for other items, including reusable gowns, resuable pocket masks, and eye shields, increased only slightly.

Although the hospital's service area (eatern Iwoa and western Illinois) has a relatively low prevalence of HIV infection, the number of patients with AIDS or sero-positive for HIV seen annually as outpatients increased from 172 visits in 1987 to 1,582 visits in 1990. The number of outpatient visits by such patients increased by 30% from 1989 to 1990. Similarly, the number inpatients with AIDS or seropositive for HIV increased from 22 in 1987 (42 visits) to 76 in 1990 (162 visits).

Probably due to the increased use of disposable sharps containers, the study found that the frequency of needle and sharps injuries decreased 21%. It went from 14.0 such injuries per 100 high-risk employees in 1989 to 11.0 in 1990, the lowest rate for the six years measured.

On the compliance with universal precuations, the study reported that 71.6% of the hospital's health care workers always use rubber gloves when contact with blood or body fluids is expected. (MLO's national survey on this subject in April 1990 reported routine glove use of 84% to 96% for various lab procedures.)

The Iowa authors extrapolated their universal precautions costs national and came up with a U.S. figure of $336 million for the year 1989. This is considerably higher that the ISHA estimate of $195 million annually for hospitals to meet the cost of its proposed rules on occupational exposure to bloodborne pathogens. Those rules have not been finalized yet, but others have also charged that OSHA grossly underestimated the cost of its rule making.

(1) Doebbeling, B.N., and Wenzel, R.P. The direct costs of universal precuations in a teaching hospital. JAMA 264(16): 2083-2087, 1990.
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Author:Fitzgibbon, Robert J.
Publication:Medical Laboratory Observer
Article Type:editorial
Date:Feb 1, 1991
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