Publication: Cost-effectiveness of interventions to improve hand hygiene in healthcare workers in middle-income hospital settings: a model-based analysis
Issued Date
2018-10-01
Resource Type
ISSN
15322939
01956701
01956701
Other identifier(s)
2-s2.0-85050990382
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of Hospital Infection. Vol.100, No.2 (2018), 165-175
Suggested Citation
N. Luangasanatip, M. Hongsuwan, Y. Lubell, D. Limmathurotsakul, P. Srisamang, N. P.J. Day, N. Graves, B. S. Cooper Cost-effectiveness of interventions to improve hand hygiene in healthcare workers in middle-income hospital settings: a model-based analysis. Journal of Hospital Infection. Vol.100, No.2 (2018), 165-175. doi:10.1016/j.jhin.2018.05.007 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/46297
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Title
Cost-effectiveness of interventions to improve hand hygiene in healthcare workers in middle-income hospital settings: a model-based analysis
Abstract
© 2018 The Author(s) 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.