Cost-effectiveness of interventions to improve hand hygiene in healthcare workers in middle-income hospital settings: a model-based analysis. Issue 2 (October 2018)

• Record Type: Journal Article
• Authors: Luangasanatip, N.; Hongsuwan, M.; Lubell, Y.; Limmathurotsakul, D.; Srisamang, P.; Day, N.P.J.; Graves, N.; Cooper, B.S.
• Is Part Of: Journal of hospital infection. Volume 100:Issue 2(2018)
• Page Start: 165
• Page End: 175
• Publication Date: 2018-10
• Subjects: Cost-effectiveness -- Hand hygiene -- Healthcare workers -- Bloodstream infections -- Staphylococcus aureus -- Hospital; Cross infection -- Periodicals; Cross infection -- Prevention -- Periodicals; Nosocomial infections -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Cross Infection -- Periodicals; Cross Infection -- prevention & control -- Periodicals; Infection Control -- Periodicals; Electronic journals; 614.44
• DOI: 10.1016/j.jhin.2018.05.007
• Languages: English
• ISSNs: 0195-6701

Abstract

Summary: Background: Multi-modal interventions are effective in increasing hand hygiene (HH) compliance among healthcare workers, but it is not known whether such interventions are cost-effective outside high-income countries. Aim: To evaluate the cost-effectiveness of multi-modal hospital interventions to improve HH compliance in a middle-income country. Methods: Using a conservative approach, a model was developed to determine whether reductions in meticillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSIs) alone would make HH interventions cost-effective in intensive care units (ICUs). Transmission dynamic and decision analytic models were combined to determine the expected impact of HH interventions on MRSA-BSI incidence and evaluate their cost-effectiveness. A series of sensitivity analyses and hypothetical scenarios making different assumptions about transmissibility were explored to generalize the findings. Findings: Interventions increasing HH compliance from a 10% baseline to ≥20% are likely to be cost-effective solely through reduced MRSA-BSI. Increasing compliance from 10% to 40% was estimated to cost US$2515 per 10, 000 bed-days with 3.8 quality-adjusted life-years (QALYs) gained in a paediatric ICU (PICU) and US$1743 per 10, 000 bed-days with 3.7 QALYs gained in an adult ICU. If baseline compliance is not >20%, the intervention is always cost-effective even with only a 10% compliance improvement. Conclusion: Effective multi-modal HH interventions are likely to be cost-effective due to preventing MRSA-BSI alone in ICU settings in middle-income countries where baseline compliance is typically low. Where compliance is higher, the cost-effectiveness of interventions to improve it further will depend on the impact on hospital-acquired infections other than MRSA-BSI.