Do Reductions in MRSA Bloodstream Infections Make Hand Hygiene Interventions Cost-Effective in ICUs?

Multimodal interventions are effective in increasing hand hygiene compliance among healthcare workers, but it is not known whether such interventions are cost-effective outside high-income countries. Luangasanati, et al. (2015) sought 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 northeast Thailand. Sensitivity analyses were performed with different values for MRSA transmissibility and colonization prevalence on admission.

Interventions increasing hand hygiene compliance from a 10 percent baseline to ≥20 percent are likely to be cost-effective solely through reduced MRSA-BSI. Increasing compliance from 10 percent to 40 percent was estimated to cost $89 per bed-year with 4·07 QALYs gained per 10,000 bed-days in the pediatric ICU (PICU) and $63 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 percent, the intervention is always cost-effective even with only a 10 percent compliance improvement.

The researchers conclude that 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.

This paper is part of the supplement Abstracts from the 3rd International Conference on Prevention and Infection Control (ICPIC 2015).

Reference: Luangasanatip N, Hongsuwan M, Lubell Y, Limmathurotsakul D, Srisamang P, Day NPJ, Graves N and Cooper BS. Cost-effectiveness of hand hygiene promotion for MRSA bloodstream infection in ICU settings. Antimicrobial Resistance and Infection Control
Volume 4 Suppl 1.