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J Hosp Infect ; 100(2): 165-175, 2018 Oct.
Article in English | MEDLINE | ID: mdl-29775628

ABSTRACT

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.


Subject(s)
Behavior Therapy/methods , Cost-Benefit Analysis , Cross Infection/prevention & control , Guideline Adherence/trends , Hand Hygiene/trends , Health Personnel , Staphylococcal Infections/prevention & control , Behavior Therapy/economics , Cross Infection/economics , Developing Countries , Disease Transmission, Infectious/economics , Disease Transmission, Infectious/prevention & control , Hospitals , Humans , Incidence , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/economics , Staphylococcal Infections/microbiology
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