Economic burden of healthcare-associated infections (HAI) in a pediatric hospital in Honduras
Authors: Molina Sara Eloisa Rivera , Murillo Sairy Natalia Pérez , Rubio Zerón Norma Judith , Morales Marcela Alejandra Orellana , Zepeda Humberto Amador , Bocanegra Fernando , Salinas Lesly , Cartagena Héctor Enrique Alfaro 
Published: October 2024

Abstract

Background
In numerous reports, the World Health Organization has published that in LMICs approximately 15% of hospitalized patients acquire an HAI. In the Region of the Americas, many countries have made considerable progress in implementing IPC Programs.
At Hospital María Especialidades Pediátricas (HMEP), the IPC Program aims to generate a patient safety culture mainly, but also reduce costs for the hospital and the patient. However, in LMICs, non-quality costs, including those associated with HAI, are rarely measured. This abstract aims to demonstrate the economic burden of HAI in hospitalized patients at HMEP between January 2020 and October 2023 and estimate the number of HAIs and associated costs prevented by the IPC Program.

Methods
At HMEP the IPC Program started in 2017, and the Accounting Department has measured the costs associated with treating and managing every HAI reported since January 2020. Provider costs for every HAI are estimated using a bottom-up (microcosting) approach in which three variables are considered: days of stay, all laboratory tests used for diagnosis and follow-up, and antimicrobials administered to treat the infection. The costs for each variable derive from the hospital’s purchasing system. This process allows us to estimate the annual HAI expenditure.
For the estimation of costs avoided, we first calculated the average cost of each HAI using the yearly amount spent and dividing this amount by the number of HAIs registered in the same period. Considering the proportion of patients who suffered an HAI at HMEP compared to the 15% incidence reported by the WHO, we calculated a difference in proportions and were able to estimate the number of HAIs prevented and subsequent costs avoided.
We use the NHSN HAI definitions since Honduras does not have a National IPC Program with standardized epidemiological criteria. The results are presented using descriptive statistics.

Results
During this time, 260 HAIs were identified at HMEP, average 5.6 per month, 57-70 yearly. The proportion of patients who developed an HAI was found to have decreased from 8.6% in 2020 to 5.2% in 2023. The total expenditure attributed to HAIs during the period was USD 913,774.21 (USD 19,865.0 pm). The costliest HAIs were CVC-associated bloodstream infections.
HMEP is a public hospital and operates with funds provided by the government, which are deemed insufficient considering the complexity of the patients receiving care at the hospital. The estimated costs represent 2-3% of the hospital’s annual budget.
Without the IPC Program, the predicted number of HAIs, according to the WHO, would have been 570 (15% of inpatients). We estimate 310 prevented HAIs, with an associated total cost of USD 1,103,577.99.

Conclusion
Regardless of the hospital’s methodology, measuring the economic burden related to HAIs is important for decision-making. The main objective of an IPC Program is to guarantee patient safety; however, especially in low-resource settings, it is also important to aim for a cost reduction.
Limitations: our methodology does not include other variables (e.g. human resources); therefore, the data underestimates the real expenditure. We aim to improve the costing methodology for more accurate data.