Cost-effectiveness of hand hygiene promotion for MRSA blood stream infection in ICU settings
Antimicrobial Resistance and Infection Control volume 4, Article number: O50 (2015)
Multimodal interventions are effective in increasing hand hygiene compliance amongst healthcare workers, but it is not known whether such interventions are cost-effective outside high-income countries.
To determine whether reductions in Methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSI) alone would make hand hygiene interventions cost-effective in intensive care units (ICUs) in a middle-income country using a model-based framework.
Transmission dynamic and decision analytic models were combined to determine the expected impact of hand hygiene interventions on MRSA-BSI incidence and evaluate their cost-effectiveness. Epidemiological and economic parameters were derived using data from a tertiary hospital in North-east Thailand. Sensitivity analyses were performed with different values for MRSA transmissibility and colonization prevalence on admission.
Interventions increasing hand hygiene 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 89·1 per bed-year with 4·07 QALYs gained per 10,000 bed-days in the paediatric ICU (PICU) and $US 63·3 per bed-year with 4·03 QALYs gained per 10,000 bed-days in the adult ICU. If baseline compliance is not greater than 20%, the intervention is always cost-effective even with only a 10% compliance improvement.
Effective multimodal hand hygiene interventions are likely to be cost-effective in ICU settings in typical middle-income countries where baseline compliance is low due to preventing MRSA-BSI alone. Where compliance is higher, the cost-effectiveness of interventions to improve it further will depend on the impact on HAIs other than MRSA-BSI.
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Luangasanatip, N., Hongsuwan, M., Lubell, Y. et al. Cost-effectiveness of hand hygiene promotion for MRSA blood stream infection in ICU settings. Antimicrob Resist Infect Control 4 (Suppl 1), O50 (2015). https://doi.org/10.1186/2047-2994-4-S1-O50