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Friday, March 7, 2014

Measles - just when we thought they were "wiped" away!


You may be thinking that vaccinations and disinfection really do not have much in common.  If you'll pardon my pun, vaccinations and disinfection both "wipe" germs away and both directly work toward the prevention of outbreaks.   Why then, with a disease such as Measles which most would say we've conquered are we seeing increased reporting of outbreaks?  What impact does this have on society not only in terms of illness and deaths, but the economic burden to our healthcare infrastructure? 

Yesterday, Ottawa Public Health announced their first lab-confirmed case of measles since 2011 and the European Centre for Disease Control (ECDC) confirmed there has been a measles outbreak onboard a cruise ship that had travelled between Spain and Italy.   If you didn't already know, measles is considered one of the MOST contagious infectious diseases.  In fact it is one of the leading causes of death among young children even though there is a safe and cost effective vaccine available.  Prior to widespread vaccination in the 1980's measles caused 2.6 million deaths each year (based on my age, I could have been one of the unlucky children...).  To give an idea of the significance of measles from a cost perspective,  Massachusetts reported that in 2011 there were 107 confirmed cases in their state which cost local and state officials between $2.7 million and $5.3 million!

Measles has a long incubation period - anywhere from 7 - 18 days.  A person is considered infectious from about 4 days before the rash starts to 4 days after the rash appears.  The virus itself is transmitted by airborne droplets or direct contact with nasal or throat secretions, but can also spread through contact with surfaces or fomites that have been contaminated with nasal and throat secretions.    No wonder it's so contagious!  You have 4 days to walk around infecting people before you know you're sick, a perfect storm not just onboard cruise ships, but any public setting!

As we know, there is no singular step, process or intervention that can stop the spread of germs.   PREVENTION is our best line of defense.  The use of vaccinations certainly play a very important role in preventing outbreaks. Hand Hygiene as we know plays probably the single most important role in preventing transmission of germs not just in healthcare settings, but all community settings.  Cleaning and Disinfection as we have mentioned in numerous blogs plays an important part in not just the prevention of transmission, but intervention of outbreaks that do occur.

When talking about infection prevention programs, cost is often a road block to implementation.    In the US, a cost-benefit analysis showed that every dollar invested in a vaccine dose saves $2 to $27 in health costs which equates to cost savings of millions upon millions of dollars.  We also know that every day, about 1 in every 20 hospitalized patients will get an infection caused by receiving medical care which relates to an overall direct cost of HAIs in hospitals ranging from US$28 billion to 45 billion.

When it comes to hand hygiene, studies have shown a linear relationship exists between hand hygiene compliance and HAI rates. For each 1% increase in hand hygiene compliance, there is a 0.6% decline in the prevalence rate of Methicillin-Resistant Staphylococcus Aureus (MRSA). Increasing hand hygiene compliance can save hospitals big money by avoiding HAI related costs and freeing up beds. As an example, a hospital that improves its compliance rate from 40% to 80% could experience a 24% decline in infections.  A hospital with a history of 50 HAIs per year means they can prevent 12 HAIs and if we assume an average cost of $43,000 per infection, the hospital would save $516,000 per year in HAI related costs.

Similarly, there are studies to support that improved Environmental Hygiene programs can directly impact HAIs.   The contribution to reducing HAIs varies, but from work I have reviewed a 20% reduction from improved cleaning and disinfection programs is reasonable.  This would mean a prevention of 10 HAIs (remember the hospital has 50/yr) - a savings of $430,000 per year!

The savings add up!  What would our healthcare system look like if we had 100% vaccination rates, 100% hand hygiene compliance and environmental hygiene programs that have sufficient staff and allow sufficient time to cleaning and disinfect......NIRVANA!

Bugging Off!

Nicole

 

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