"Cost-effectiveness of interventions to improve hand hygiene in healthcare workers in middle-income hospital settings: a model-based analysis".
Luangasanatip N., Hongsuwan M., Lubell Y., Limmathurotsakul D., Srisamang P., Day NP., Graves N., Cooper BS.
Multimodal interventions are effective in increasing hand hygiene (HH) compliance amongst healthcare workers, but it is not known whether such interventions are cost-effective outside high-income countries.To evaluate the cost-effectiveness of multimodal hospital interventions to improve hand hygiene (HH) compliance in a middle-income country.We adopted a conservative approach by developing a model to determine whether reductions in Methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSI) 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 generalise the 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$ 2,515 per 10,000 bed-days with 3.8 QALYs gained in a paediatric ICU (PICU) and US$ 1,743 per 10,000 bed-days with 3.7 QALYs gained in an 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 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.