What are these costs ?
Previously we summarized what types of Electronic Compliance Monitoring System exist, and described how ECM systems are used in the real clinical settings. Now, we are further investigating what costs are associated with these systems.
Installation cost
Installation of a location-based monitoring system is a big investment. Armellino et al. 2012 described the installation of a video-monitoring system in a 17-bed medical ICU, costing $50,000, and it is not including the salary of the observer who manually analyses the recorded video [1, 2]. Morgan et al. 2012 installed an electronic dispenser counter system. They estimated the installation and maintenance cost for a 15-bed ICU between $30-40,000. Marra et al. 2014 implemented another electronic dispenser counter system in a 20-bed step-down unit, where the cost was approximately $50,000 [2, 3, 4]. Filho et al. 2014 installed a dispenser-based monitor system, the cost of installation and initial maintenance was $50,000 [5]. Storey et al. 2014 implemented an alcohol sensor monitoring system (Green Badge System), which costed £150 per bed for equipment an £12 per bed per year for maintenance [6].
Some other costs, related to the application of ECM systems
Some systems require that existing dispensers be replaced, which increases installation cost. The majority of systems use wireless network, others require fixed wiring, which necessitates removing ceiling tiles and/or drilling into walls to mount sensors in the patient zone. Many dispensers are battery-powered and need frequent inspection and replacement. i-Healthsys system badges use 2 button batteries, which need to be changed monthly [2].
HyGreen used to have wall-mounted sensors that means healthcare workers need to pass a disinfected hand within 2–10 cm of a sensor to be recognized as compliant. This requires healthcare worker to modify their daily routine. All of these additional steps during the daily routine may be the burden of human resources [2].
Pineles et al. 2014 described what factors they considered before they choose an ECM system.
Figure 1: Comparison of some ECM systems (Source: Pineles et al. 2014)
Modular systems
Location-based systems need to be installed at once for the whole unit or ward; all rooms and hallways need to be equipped, and every healthcare worker needs a batch for. Technique monitoring systems (e.g., SureWash and Semmelweis Scanner) can be modularly installed. These devices are portable; thus a few devices may be sufficient for the whole unit, or for the whole hospital for the validation period. Of course, continuous relocation of the device can be human-resource intensive, thus the systems can later be expanded with additional devices.
Figure 2: One of the technique monitoring systems, the Semmelweis Scanner.
ECM systems can reduce the cost of infections
Kelly et al. 2016 examined a 33-month period, and found a significant correlation between improvements in electronic monitoring compliance and reductions in methicillin-resistant Staphylococcus aureus (MRSA) infection rates. They used the DebMed system, and also continued to perform direct observation. After installation of the ECM system hand hygiene compliance improved by 25.5%, and it was associated with decreased rates of MRSA infections. Based on the decrease of the MRSA rate, they calculated that 24 MRSA cases were prevented, and that resulted in approximately $434,000 in hospital cost savings (approx. $160,00/year) [8].
Conclusion:
There are two types of ECM systems; location-based systems and technique monitoring systems. Installing a location-based system means great investment, as the whole system needs to be built once. Technique monitoring systems can be build-up modularly, and even one single device can be enough for the start of using system.
Read our previous post about the clinical usage of ECM systems. Please stand by for our next blog entry on the comparison for hand sanitizing liquids, gels, and foams.