JOURNAL REVIEWS

JOURNAL REVIEWS

Rentz AM, Halpern MT, Bowden R, et al. The impact of candidemia on length of hospital stay, outcome, and overall cost of illness. Clin Infect Dis 1998; 27:781-788.

In findings that underscore the economic impact of preventing infections, the authors found that each case of nosocomial candidemia in the United States costs between $34,123 and $44,536.

The study design was a cost-of-illness analysis estimating the average cost of candidemia for a single episode of care. Data were obtained from three sources: the 1993 Healthcare Cost and Utilization Project of the Agency for Health Care Policy and Research; the relevant literature; and a clinical expert in systemic fungal infections. The estimated cost (1997 U.S. dollars) of an episode of care for candidemia was $34,123 per Medicare patient and $44,536 per private insurance patient. The major cost associated with candidemia was increased hospital stay. The estimated cost of care for candidemia may change in the future because of the use of more expensive antifungal treatments with improved safety and efficacy profiles, the authors note.

"The need to care for hospitalized patients properly and to prevent nosocomial infections from occurring assumes greater consequences in an era of health care reform, where the emphasis is on providing effective treatments while simultaneously lowering costs," the authors conclude. "Thus, new strategies to prevent systemic fungal infections will be increasingly important."

In the future, the greatest impact on cost of treatment will be the availability of lipid-complexed amphotericin B, which — while associated with reduced adverse events (especially nephrotoxicity) — costs 10 times as much as amphotericin B on a daily basis.

"Using lipid-complexed amphotericin B will reduce costs associated with adverse events and discontinuation of therapy but will still result in an increase in overall cost of care for candidemia patients," the authors add.

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Jeffe DB, Mutha S, Kim LE, et al. Does clinical experience affect medical students’ knowledge, attitudes, and compliance with universal precautions? Infect Control Hosp Epidemiol 1998; 19:767-771.

The optimal time to impress medical students with the critical importance of using universal precautions to prevent occupational exposures to bloodborne pathogens is in the preclinical years when they have limited experience, the authors conclude.

To investigate differences in second-, third-, and fourth-year medical students’ knowledge of bloodborne pathogen exposure risks, as well as their attitudes toward and intentions to comply with universal precautions (UP), they conducted a cross-sectional survey. Surveys about students’ knowledge, attitudes, and intentions to comply with UP were completed by 111 second-year (preclinical), 80 third-year, and 60 fourth-year medical students at Washington University School of Medicine in the spring of 1996.

Preclinical students knew more than clinical students about the efficacy of hepatitis B vaccine, use of antiretroviral therapy after occupational exposure to human immunodeficiency virus, and nonvaccinated health care workers’ risk of infection from needlestick injuries. Students’ perceived risk of occupational exposure to bloodborne pathogens and attitudes toward hepatitis B vaccine did not differ, but preclinical students agreed more strongly that they should double-glove for all invasive procedures with sharps. Clinical students agreed more strongly with reporting only high-risk needlestick injuries and with rationalizations against using UP.

"Given these observations, we believe that knowledge about the need for UP and utilization of safe procedures (e.g., no touch’ passing of sharps and not manipulating suture needles with one’s hands) should be taught to students before they begin their clinical rotations," the authors report. "Their attitudes toward UP might remain more positive after gaining clinical experience if they are taught to use recommended precautions from the beginning."