Can the Adoption of Single-use Blood-pressure Cuffs Reduce Healthcare Costs?

There are many causes of HAIs, including catheters, surgery, injections, improperly disinfected facilities, the transmission of communicable diseases between patients and health care workers, and overuse or improper use of antibiotics.² The adoption of single-patient-use (SPU) blood-pressure (BP) cuffs could effectively eliminate one common source of contamination. Though the direct cost of SPU cuffs may be more than that of reusable cuffs, the extra cost is offset by the savings achieved through reducing the risk of potential infections, as explained in a white paper by Bruce Friedman.³

Impact of Blood Pressure Cuffs on HAIs

BP cuffs are one of the most frequently used medical devices, yet they are routinely ignored or inadequately handled when it comes to cleaning.^4,5 Contamination among patients with pathogens cultured from BP cuffs has occurred even following disinfection of said equipment.⁵

Many studies have demonstrated the presence of contaminants on BP cuffs, including Clostridium difficile,⁶ methicillin-resistant Staphylococcus aureus (MRSA),^7–10 Acinetobacter baumannii,^9,11 and Escherichia coli and pseudomonas.⁷ Bacteria such as MRSA and vancomycin-resistant enterococci (VRE) in particular can remain viable for days on BP cuffs and other surfaces.^8,12

BP cuffs are increasingly being recognized as potential vectors for HAIs. Clinical guidance from the 2008 Massachusetts Department of Public Health recommends that disposable BP cuffs be used in acute-care hospitals.¹³ 

Similarly, the Society for Healthcare Epidemiology of America guidelines for preventing the transmission of MRSA and VRE highlight that shared patient equipment, including BP cuffs, can transmit infections between patients.¹⁴

How SPU BP cuffs decrease the risk of HAIs

Infections are known to significantly increase patient care costs, hospital stay lengths, and mortality rates.^15,16 The adoption of SPU cuffs could potentially reduce the frequency of HAIs, thereby improving patient outcomes, decreasing mortality, and markedly reducing financial burden.

One method of calculating the financial benefit of a device intended to prevent or reduce adverse events (such as HAIs) involves a formula used in risk-assessment cases, which is expressed as follows in Equation 1¹⁷:

• B < P × L

This formula demonstrates that the cost of precautions taken to reduce an adverse event (B) can be economically justified if it is less than the product of the probability of occurrence (P) and the magnitude (L) of the resulting harm (i.e., the cost to treat the infection).

Reports have shown that the median cost of HAIs ranges between $25,000 and $40,000.^15,18,19 For the purpose of the present discussion, the low end of this range will be used for L in Equation 1.

Reported rates of HAIs range from 9.8 to 23.7 per 1,000 patient-days.^20,21 To accurately determine costs for SPU cuffs, HAI rates need to be adjusted for length of stay (LOS).²¹ Data from the Agency for Healthcare Research and Quality indicate that the average LOS for patients in acute-care hospitals is 4.6 days.²² Based on LOS, the probability of an HAI can be calculated as follows in Equation 2:

• Rate of HAIs = 0.0098/day
• Average LOS (ALOS) = 4.6 days
• Probability of an HAI occurring in an individual patient during their stay = HAI × ALOS = 0.0098/day × 4.6 days = 0.0451

Placing these data into the risk formula (Equation 1) yields the following:

• B < P × L
• 0.0451 × $25,000
• $1,127

Even though clinicians may change gloves and/or wash hands between patients, the BP cuffs themselves are not always cleaned or are cleaned inadequately.⁵ Beggs et al.’s study on hand-washing considered a 10% probability of patient-to-clinician transmission as well as a similar probability that a clinician would transmit the infection to another patient,²³ resulting in a transmission rate of 1%. If this rate of transmission is assumed, then the acceptable per-patient cost would be as follows in Equation 3:

• ($1,127 × 1%) = $11.27

Conclusion

Since single-use BP cuffs cost much less than the estimated $11.27 calculated in the above risk-assessment model, their use for reducing HAI risk can be clearly justified.²⁵ Moreover, this analysis does not account for the initial purchase price of reusable cuffs, or the cost of cleaning and disinfecting them, which would provide further rationale for the role of SPU cuffs in preventing contamination.

References

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