Simple Low Cost Interventions Yielding Extraordinary Outcomes

The Industry Today

• Centers for Disease Control (CDC)

• Center for Medicare/Medicaid Services (CMS)– POA 10/1/08

• Mandatory Reporting

• Institute for Healthcare Improvement (IHI)

• Consumerism

• Food and Drug Administration (FDA)

The Industry Today

• Infection tracking begins Oct. 1, 2007

• Reporting begins Oct. 1, 2008

• Pressure Ulcers

• Vascular and Urinary Tract Infections from catheters

• Mediastinitis

• Falls

• “Never Events”

• VAPs (2009)

Center for Medicare/Medicaid Services (CMS)Center for Medicare/Medicaid Services (CMS)

Source: Federal Register, Vol 72, No 162, August 22, 2007

The Challenges

Pressure Ulcers $30,0001

UTI’s $4,7002

SSI’s $25,5003

MRSA SSI’s $100,0004

VAP’s $40,0005

Hospital Acquired Infection (HAIs) Hospital Acquired Infection (HAIs) costs cited in the literaturecosts cited in the literature

(per event)(per event)

1. Amlung SR, et al, Adv Skin Wound Care, Nov/Dec 2001; 14(6):297-301. 2. Chen Yin-Yin, Chou Yi-Chang, Chou Pesus. Impact of nosocomial infection on the cost of illness and length of stay in intensive care units. Infection Control Hosp Epidemiology 2005; 26:281-7. 3. Stone PW, et al, Am J Infec Control. Nov 2005; 33(9): 501-9. 4. Engemann JJ, et al, Clin Infec Dis 1 March 2003; 36(5): 592-8. 5. Rello J, et al, Chest, Dec 2002; 122(6):2115-21.

The Sage Solution

• Fundamental belief in prevention versus treatment

• Simple, low cost interventions

• Documented success as Best Practice

• Focused effort

Bathing

Risk factors for HAI’s and Early

Detection of Skin Injury

Incontinence Care, Heel Floatation

Risk Factors for Pressure Ulcers

Oral Care

Risk factors for Hospital Acquired

Pneumonia

Preoperative Skin

Preparation

Risk of Surgical Site Infection

Interventional Patient Hygiene

The Sage Solution

• Second most common pressure ulcer1

• Many products on market are ineffective

• Proven outcomes in heel ulcer reduction2

Issue: Pressure Ulcers — Heels

1 Whittington KT, Briones R, Adv Skin Wound Care. Nov/Dec 2004; 17(9):490-42 Walsh JS, Plonczynski DJ, Journal of Wound, Ostomy & Continence Nursing. March/April 2007; 34(2):178-183

Cost of intervention: $100 per patient

Garrett D, Intervention with a new heel protection device and silver alginate dressing to prevent amputation of lower leg due to stage IV ulcer of the heel and malleolus. Case study conducted at Salem Village Nursing and Rehabilitation Center, Joliet IL, Oct 2006

The Sage SolutionIssue: Pressure Ulcers — Heels

• All-in-one approach to Incontinence Associated Dermatitis (IAD)

• Barrier solution inthe cloth

• Proven reduction in IAD of up to 62%

Driver S., Crit Care Nurse 2007 Aug: 27(4): 42-46

The Sage SolutionIssue: Skin Injury (Pressure Ulcers)

Cost per LOS for the patient with fecal incontinence: $12

Sluser S, Consistency the key for treating severe perineal dermatitis due to incontinence.Poster presented at the Clinical Symposium on Advances in Skin and Wound Care (ASWC), Las Vegas, NV, 2005 Oct.

Issue: Skin Injury (Pressure Ulcers)

The Sage Solution

• Unique solution of 2% CHG lefton skin

• Documented reduction of MDROs

• Proven reduction in infections

The Sage SolutionIssue: Surgical Site Infections — MRSA

1 Prospective evaluation of six pre-operative cutaneous antiseptic regimens for prevention of surgical site infection, Poster presented at SHEA Conference, March 2006, Maki DG, Paulson DS. 2. Pre-operative Skin Preparation Protocol Results in Reduced SSI Rates, Rhee H, MD, Chair Infection Control Committee and Harris B, CIC, Infection Control Practitioner, Presented at Institute for Healthcare Improvement (IHI) Orlando, FL, December 2007.

Cost per patient per surgery: $5.50 per day

Issue: Surgical Site Infections — MRSA

The Sage Solution

• Comprehensive approach to oral care

• Market share leader1

• Five years of clinical success documenting dramatic reduction and even elimination of VAP2

The Sage SolutionIssue: Ventilator Associated Pneumonia (VAP)

1 Based on GHX market share data, 2007 Suction Oral Care and Non-Suction Oral Care categories2 Studies and symposia presentations found at http://www.sageproducts.com/education/vsymposiaPres.asp and http://www.sageproducts.com/education/varticles.asp

Average cost per patient in ICU: $100

Issue: Ventilator Associated Pneumonia (VAP)

The Sage Solution

Revenue PreservationPotential investment per ICU patient

Incontinence $12/stay

Prevalon Boot $100/pair

Comfort Bath $6/stay

CHG $11/stay

Oral Care $100/stay

TOTAL $229/stay*

* Assumes ICU average LOS 3.2 days. Additional $44.25./day after 3 days

Condition Cost per each Intervention Cost per intervention

Pressure Ulcers $30,000 per1 Comfort Shield $12/stay*

VAPs $40,000 per2 Oral Care $100/stay

UTIs $4,700 per3 Comfort Bath $6/stay

Heel Ulcers $30,000 per1 Prevalon $100/pr

MRSA SSIs $100,000 per4 CHG $11/stay

1. Amlung SR, et al, Adv Skin Wound Care, Nov/Dec 2001; 14(6):297-301. 2. Rello J, et al, Chest. 2002. Dec; 122 (6):2115-21. 3. Chen Yin-Yin et al, Infect Control and Epidem. March 2005; 26:281-7. 4. Engemann JJ, et al., Clin Infect Dis. 1 Mar 2003; 36(5): 592-3-8. * Assumes ICU average LOS 3.2 days.

Simple, low cost interventions

• Focus

• Educate

• Implement

• Measure

• Delivered Outcomes

Sage Commitment

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