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

White, Nicole M., Barnett, Adrian G., Hall, Lisa, Mitchell, Brett G., Farrington, Alison, Halton, Kate, Paterson, David L., Riley, Thomas, Gardner, Anne, Page, Katie, Gericke, Christian A., and Graves, Nicholas (2020) Cost-effectiveness of an environmental cleaning bundle for reducing healthcare-associated infections. Clinical Infectious Diseases, 70 (12). pp. 2461-2468.

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Background. Healthcare-associated infections (HAIs) remain a significant patient safety issue, with point prevalence estimates being similar to 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.

Item ID: 64068
Item Type: Article (Research - C1)
ISSN: 1537-6591
Keywords: cost-effectiveness, infection control, healthcare-associated infections, environmental cleaning, hospital
Copyright Information: © 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 (, 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.
Funders: National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC GNT1076006
Date Deposited: 12 Aug 2020 07:48
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420311 Health systems @ 50%
42 HEALTH SCIENCES > 4203 Health services and systems > 420306 Health care administration @ 50%
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