Cost-effectiveness of an Environmental Cleaning Bundle for Reducing Healthcare-associated Infections

Nicole M White; Adrian G Barnett; Lisa Hall; Brett G Mitchell; Alison Farrington; Kate Halton; David L Paterson; Thomas V Riley; Anne Gardner; Katie Page; Christian A Gericke; Nicholas Graves

doi:10.1093/cid/ciz717

Cost-effectiveness of an Environmental Cleaning Bundle for Reducing Healthcare-associated Infections

Clin Infect Dis. 2020 Jun 10;70(12):2461-2468. doi: 10.1093/cid/ciz717.

Authors

Nicole M White^{1

2}, Adrian G Barnett^{1

2}, Lisa Hall^{2

3}, Brett G Mitchell^{4

5}, Alison Farrington^{1

2}, Kate Halton², David L Paterson⁶, Thomas V Riley^{7

8

9}, Anne Gardner², Katie Page², Christian A Gericke^{10

11}, Nicholas Graves^{1

2}

Affiliations

¹ Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia.
² School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia.
³ School of Public Health, University of Queensland, Brisbane, Western Australia.
⁴ Discipline of Nursing, Avondale College of Higher Education, Wahroonga, New South Wales, Western Australia.
⁵ School of Nursing and Midwifery, University of Newcastle, New South Wales, Western Australia.
⁶ University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Crawley, Western Australia.
⁷ School of Biomedical Sciences, The University of Western Australia, Crawley, Western Australia.
⁸ School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia.
⁹ School of Veterinary and Life Sciences, Murdoch University, Western Australia,, Cairns, Queensland, Australia.
¹⁰ School of Clinical Medicine, University of Queensland, Cairns, Queensland, Brisbane, Australia.
¹¹ College of Public Health, Medical and Veterinary Sciences, and College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.

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.

Keywords: cost-effectiveness; environmental cleaning; healthcare-associated infections; hospital; infection control.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Clostridium Infections*
Cost-Benefit Analysis
Cross Infection* / epidemiology
Cross Infection* / prevention & control
Delivery of Health Care
Humans