How do we evaluate the cost of nosocomial infection? The ECONI protocol: an incidence study with nested case-control evaluating cost and quality of life

Sally Stewart, Chris Robertson, Sarkis Manoukian, Lynne Haahr, Helen Mason, Agi McFarland, Stephanie Dancer, Brian Cook, Jacqui Reilly, Nicholas Graves, ECONI Steering Committee, Mahmood Adil, Alistair Leanord, Rachel Dunk, Abigail Mullings, Elaine Ross, Lisa Ritchie, Moira Whyte, Louise Brown, Sally Stewart, Chris Robertson, Sarkis Manoukian, Lynne Haahr, Helen Mason, Agi McFarland, Stephanie Dancer, Brian Cook, Jacqui Reilly, Nicholas Graves, ECONI Steering Committee, Mahmood Adil, Alistair Leanord, Rachel Dunk, Abigail Mullings, Elaine Ross, Lisa Ritchie, Moira Whyte, Louise Brown

Abstract

Introduction: Healthcare-associated or nosocomial infection (HAI) is distressing to patients and costly for the National Health Service (NHS). With increasing pressure to demonstrate cost-effectiveness of interventions to control HAI and notwithstanding the risk from antimicrobial-resistant infections, there is a need to understand the incidence rates of HAI and costs incurred by the health system and for patients themselves.

Methods and analysis: The Evaluation of Cost of Nosocomial Infection study (ECONI) is an observational incidence survey with record linkage and a nested case-control study that will include postdischarge longitudinal follow-up and qualitative interviews. ECONI will be conducted in one large teaching hospital and one district general hospital in NHS Scotland. The case mix of these hospitals reflects the majority of overnight admissions within Scotland. An incidence survey will record all HAI cases using standard case definitions. Subsequent linkage to routine data sets will provide information on an admission cohort which will be grouped into HAI and non-HAI cases. The case-control study will recruit eligible patients who develop HAI and twice that number without HAI as controls. Patients will be asked to complete five questionnaires: the first during their stay, and four others during the year following discharge from their recruitment admission (1, 3, 6 and 12 months). Multiple data collection methods will include clinical case note review; patient-reported outcome; linkage to electronic health records and qualitative interviews. Outcomes collected encompass infection types; morbidity and mortality; length of stay; quality of life; healthcare utilisation; repeat admissions and postdischarge prescribing.

Ethics and dissemination: The study has received a favourable ethical opinion from the Scotland A Research Ethics Committee (reference 16/SS/0199). All publications arising from this study will be published in open-access peer-reviewed journal. Lay-person summaries will be published on the ECONI website.

Trial registration number: NCT03253640; Pre-results.

Keywords: case-control study; healthcare associated infection; incidence; infection control; mortality; quality of life.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Representation of the Evaluation of Cost of Nosocomial Infection nested study design. The incidence cohort represents all adult overnight admission to the study hospitals. The case-control study will be a subset of cases and controls (two controls for each case) and the nested qualitative study will recruit a subset of patients who develop healthcare-associated or nosocomial infection (HAI) and have consented to participate in the case-control study. A proportion of HAI cases will not be able or willing (including by proxy) to provide consent to participate in the case-control study.
Figure 2
Figure 2
Evaluation of Cost of Nosocomial Infection study flow chart. HAI, Healthcare Associated Infection or Nosocomial Infection.
Figure 3
Figure 3
ECONI data linkage. Data sets which will be combined in order to address the study research questions. ECONI, Evaluation of Cost of Nosocomial Infection; ISD, Information Services Division.

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