Aim: To determine the cost effectiveness of an infection control program to decrease the rate of nosocomial respiratory syncitial virus (RSV) infection (NI) in our 304 bed pediatric hospital. Methods: We studied community and hospital acquired RSV infection for eight consecutive RSV seasons from November 1989 to April 1996. Following the 1991-1992 RSV season, an RSV infection control program was implemented that included cohorting patients and nursing staff to use gown and glove isolation in all suspected cases of RSV, confirmation of infection by rapid antigen testing, and monitoring and education by infection control staff. Effectiveness of the program was assessed by comparing the incidence density of NI (rate per 1000 patient-days at risk) before and after introduction of the program. To control for differences in exposure opportunity due to variations in overall RSV infection rates, NI rates for each period were calculated as the weighted average of stratum-specific rates, with five monthly strata defined on the basis of the proportion of all hospital days accounted for by admissions for RSV. The cost of the RSV program was estimated as the cost of gowns and gloves, the cost of additional RSV antigen tests ordered, and personnel salary.

Results: Overall, 148 patients acquired NI (88 before, and 60 after the intervention). The Mantel-Haenszel stratified relative risk for NI in the 1992-96 period, compared to the 1988-92 seasons, was 0.61 (95% confidence interval, 0.53 to 0.69). By applying the pre-intervention stratum-specific rates of infection to the days at risk for the post-intervention period, we estimated that 100 NI would have been expected during 1992-96 period which, in comparison to the 60 NI observed, yielded an estimated program effectiveness of 10 NI prevented per season. The total cost of the program per season was calculated at $17018, including $13013 for gowns and gloves, $2511 for RSV testing, and $1494 for administrative and personnel costs. Thus, we estimate an average cost of $1702 per NI prevented.

Conclusion: A targeted infection control program was both effective and cost-effective in reducing the rate of nosocomial RSV infection. Under a DRG system of reimbursement, such a program may provide cost savings for the hospital.