Cost-effectiveness of an environmental cleaning bundle for reducing healthcare associated infections

White, NM; Barnett, AG; Hall, L; Mitchell, BG; Farrington, A; Halton, K; Paterson, DL; Riley, TV; Gardner, A; Page, K; Gericke, CA; Graves, N

Cost-effectiveness of an environmental cleaning bundle for reducing healthcare associated infections

White, NM Barnett, AG Hall, L Mitchell, BG Farrington, A Halton, K Paterson, DL Riley, TV Gardner, A Page, K

Gericke, CA Graves, N

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Publisher:: Oxford University Press (OUP)
Publication Type:: Journal Article
Citation:: Clinical Infectious Diseases, 2020, 70, (12), pp. 2461-2468
Issue Date:: 2020

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Field	Value	Language
dc.contributor.author	White, NM
dc.contributor.author	Barnett, AG
dc.contributor.author	Hall, L
dc.contributor.author	Mitchell, BG
dc.contributor.author	Farrington, A
dc.contributor.author	Halton, K
dc.contributor.author	Paterson, DL
dc.contributor.author	Riley, TV
dc.contributor.author	Gardner, A
dc.contributor.author	Page, K https://orcid.org/0000-0001-9183-9175
dc.contributor.author	Gericke, CA
dc.contributor.author	Graves, N
dc.date.accessioned	2020-10-01T22:54:24Z
dc.date.available	2019-07-29
dc.date.available	2020-10-01T22:54:24Z
dc.date.issued	2020
dc.identifier.citation	Clinical Infectious Diseases, 2020, 70, (12), pp. 2461-2468
dc.identifier.issn	1058-4838
dc.identifier.issn	1537-6591
dc.identifier.uri	http://hdl.handle.net/10453/142984
dc.description.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.
dc.format	Print
dc.language	eng
dc.publisher	Oxford University Press (OUP)
dc.relation	http://purl.org/au-research/grants/nhmrc/GNT1076006
dc.relation.ispartof	Clinical Infectious Diseases
dc.relation.isbasedon	10.1093/cid/ciz717
dc.rights	info:eu-repo/semantics/openAccess
dc.rights	Clinical Infectious Diseases® 2020;70(12):2461–8© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.comDOI: 10.1093/cid/ciz717
dc.rights	This is a pre-copyedited, author-produced version of an article accepted for publication in Clinical Infectious Diseases following peer review. The version of record Clinical Infectious Diseases, 2020, 70, (12), pp. 2461-2468 is available online at: https://dx.doi.org/10.1093/cid/ciz717.	en_US
dc.subject	06 Biological Sciences, 11 Medical and Health Sciences
dc.subject.classification	Microbiology
dc.title	Cost-effectiveness of an environmental cleaning bundle for reducing healthcare associated infections
dc.type	Journal Article
utslib.citation.volume	70
utslib.location.activity	United States
utslib.for	06 Biological Sciences
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.date.updated	2020-10-01T22:54:07Z
pubs.issue	12
pubs.publication-status	Published
pubs.volume	70
utslib.citation.issue	12

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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