The cost-effectiveness of temporary single patient rooms to reduce risks of healthcare associated infection

Abstract Background Healthcare-associated infections (HAIs) remain a significant patient safety issue, with point prevalence estimates being ~5% in high-income countries. In 2016–2017, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study implemented an environmental cleaning bundle targeting communication, staff training, improved cleaning technique, product use, and audit of frequent touch-point cleaning. This study evaluates the cost-effectiveness of the environmental cleaning bundle for reducing the incidence of HAIs. Methods A stepped-wedge, cluster-randomized trial was conducted in 11 hospitals recruited from 6 Australian states and territories. Bundle effectiveness was measured by the numbers of Staphylococcus aureus bacteremia, Clostridium difficile infection, and vancomycin-resistant enterococci infections prevented in the intervention phase based on estimated reductions in the relative risk of infection. Changes to costs were defined as the cost of implementing the bundle minus cost savings from fewer infections. Health benefits gained from fewer infections were measured in quality-adjusted life-years (QALYs). Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefit of adopting the cleaning bundle over existing hospital cleaning practices. Results Implementing the cleaning bundle cost $349 000 Australian dollars (AUD) and generated AUD$147 500 in cost savings. Infections prevented under the cleaning bundle returned a net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4684 per QALY gained. There was an 86% chance that the bundle was cost-effective compared with existing hospital cleaning practices. Conclusions A bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs.

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Cost-effectiveness analysis of an active 30-day surgical site infection surveillance at a tertiary hospital in Ghana: evidence from HAI-Ghana study

BMJ Open ◽

10.1136/bmjopen-2021-057468 ◽

2022 ◽

Vol 12 (1) ◽

pp. e057468

Author(s):

Evans Otieku ◽

Ama Pokuaa Fenny ◽

Felix Ankomah Asante ◽

Antoinette Bediako-Bowan ◽

Ulrika Enemark

Keyword(s):

Cost Effectiveness ◽

Surgical Site Infection ◽

Outcome Measures ◽

Teaching Hospital ◽

Phone Call ◽

Site Infection ◽

Surgical Wound ◽

Healthcare Associated Infection ◽

Provider Perspectives ◽

The Cost

ObjectiveTo assess the cost-effectiveness of an active 30-day surgical site infection (SSI) surveillance mechanism at a referral teaching hospital in Ghana using data from healthcare-associated infection Ghana (HAI-Ghana) study.DesignBefore and during intervention study using economic evaluation model to assess the cost-effectiveness of an active 30-day SSI surveillance at a teaching hospital. The intervention involves daily inspection of surgical wound area for 30-day postsurgery with quarterly feedback provided to surgeons. Discharged patients were followed up by phone call on postoperative days 3, 15 and 30 using a recommended surgical wound healing postdischarge questionnaire.SettingKorle-Bu Teaching Hospital (KBTH), Ghana.ParticipantsAll prospective patients who underwent surgical procedures at the general surgical unit of the KBTH.Main outcome measuresThe primary outcome measures were the avoidable SSI morbidity risk and the associated costs from patient and provider perspectives. We also reported three indicators of SSI severity, that is, length of hospital stay (LOS), number of outpatient visits and laboratory tests. The analysis was performed in STATA V.14 and Microsoft Excel.ResultsBefore-intervention SSI risk was 13.9% (62/446) as opposed to during-intervention 8.4% (49/582), equivalent to a risk difference of 5.5% (95% CI 5.3 to 5.9). SSI mortality risk decreased by 33.3% during the intervention while SSI-attributable LOS decreased by 32.6%. Furthermore, the mean SSI-attributable patient direct and indirect medical cost declined by 12.1% during intervention while the hospital costs reduced by 19.1%. The intervention led to an estimated incremental cost-effectiveness ratio of US$4196 savings per SSI episode avoided. At a national scale, this could be equivalent to a US$60 162 248 cost advantage annually.ConclusionThe intervention is a simple, cost-effective, sustainable and adaptable strategy that may interest policymakers and health institutions interested in reducing SSI.

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The Cost Effectiveness of Single-Patient-Use Electrocardiograph Cable and Lead Systems in Monitoring for Coronary Artery Bypass Graft Surgery

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2019.00061 ◽

2019 ◽

Vol 6 ◽

Cited By ~ 2

Author(s):

Rhodri Saunders ◽

Julie Lankiewicz

Keyword(s):

Cost Effectiveness ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Single Patient ◽

The Cost ◽

Patient Use

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Preoperative Use of Mupirocin for the Prevention of Healthcare-Associated Staphylococcus aureus Infections: A Cost-Effectiveness Analysis

Infection Control and Hospital Epidemiology ◽

10.1086/509837 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1304-1312 ◽

Cited By ~ 24

Author(s):

Lisa S. Young ◽

Lisa G. Winston

Keyword(s):

Staphylococcus Aureus ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Cost Saving ◽

Healthcare Associated Infections ◽

Site Infection ◽

Effectiveness Analysis ◽

Treat All ◽

Healthcare Associated ◽

The Cost

Objective.Staphylococcus aureusis the most common cause of healthcare-associated infections. Intranasal mupirocin treatment probably decreasesS. aureusinfections among colonized surgical patients. Using cost-effectiveness analysis, we evaluated the cost-effectiveness of preoperative use of mupirocin for the prevention of healthcare-associatedS. aureusinfections.Methods.Three strategies were compared: (1) screen with nasal culture and give treatment to carriers, (2) give treatment to all patients without screening, and (3) neither screen nor treat. A societal perspective was taken. Adverse outcomes included bloodstream infection, pneumonia, surgical site infection, death due to underlying illness or infection, readmission, and the need for home health care. Data inputs were obtained from an extensive MEDLINE review and from publicly available government data sources. The following base-case data inputs (and ranges) for sensitivity analysis were used: rate ofS. aureuscarriage, 23.1% (19%-55%); efficacy ofmupirocin treatment, 51% (8%-75%); mupirocin treatment cost, $48.36 ($24.18-$57.74); and hospital costs of bloodstream infection, $25,128 ($6,194-$40,211), pneumonia, $18,366 ($5,574-$28,952), and surgical site infection $16,256 ($5,119-$22,553). Widespread use ofmupirocin has been associated with high levels of mupirocin resistance; therefore, a broad range of estimates for efficacy was tested in the sensitivity analysis.Patients.The target population included patients undergoing nonemergent surgery requiring postoperative hospitalization.Results.Both the screen-and-treat and treat-all strategies were cost saving, saving $102 per patient screened and $88 per patient treated, respectively. In 1-way sensitivity analyses, the model was robust with respect to all data inputs except for the efficacy ofmupirocin treatment. If the efficacy is less than 16.1%, then the screen-and-treat strategy is cost incurring. A treat-all strategy was more cost saving if the rate ofS. aureuscarriage was greater than 42.7%, the mupirocin cost was less than $29.87, or nursing compensation was greater than $64.21 per hour.Conclusion.Administration of mupirocin before surgery is cost saving, primarily because healthcare-associated infections are very expensive. The level of mupirocin efficacy is critical to the cost-effectiveness of this intervention.

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