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Modelling the costs and consequences of reducing healthcare-associated infections by improving hand hygiene in an average hospital in England
  1. Julian F Guest1,2,
  2. Tomas Keating1,
  3. Dinah Gould3,4,
  4. Neil Wigglesworth5
  1. 1 Catalyst Consultants, Rickmansworth, UK
  2. 2 King's College London, London, UK
  3. 3 Cardiff University School of Healthcare Studies, Cardiff, UK
  4. 4 Healthcare Sciences, Cardiff University, Cardiff, South Glamorgan, UK
  5. 5 Directorate of Infection, Guy's & St Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to Dr Julian F Guest; julian.guest{at}catalyst-health.com

Abstract

Objective To assess the potential clinical and economic impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance in a hypothetical general hospital in England, to reduce the incidence of healthcare-associated infections (HCAIs).

Methods Decision analysis estimated the impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance among front-line healthcare practitioners (HCPs).

Results The model assumed 4.7% of adult inpatients (ie, ≥18 years of age) and 1.72% of front-line HCPs acquire a HCAI in current practice. The model estimated that if use of the electronic audit and feedback system could lead to a reduction in the incidence of HCAIs of between 5% and 25%, then the annual number of HCAIs avoided could range between 184 and 921 infections per hospital and HCAI-related mortality could range between 6 and 31 deaths per annum per hospital. Additionally, up to 86 days of absence among front-line HCPs could be avoided and up to 7794 hospital bed days could be released for alternative use. Accordingly, the total annual hospital cost attributable to HCAIs could be reduced by between 3% and 23%, depending on the effectiveness of the electronic audit and feedback system. If introduction of the electronic audit and feedback system into current practice could lead to a reduction in the incidence of HCAIs by at least 15%, it would have a ≥0.75 probability of affording the National Health Service (NHS) a cost-effective intervention.

Conclusion If the introduction of the electronic audit and feedback system into current practice in a hypothetical general hospital in England can improve hand hygiene compliance among front-line HCPs leading to a reduction in the incidence of HCAIs by ≥15%, it would potentially afford the NHS a cost-effective intervention.

  • cost
  • healthcare associated infections
  • HCAI
  • England, NHS, nosocomial infection

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Footnotes

  • Contributors JFG designed the study, managed the analyses, performed some analyses, checked all the other analyses and wrote the manuscript. TK conducted much of the analyses. DJG and NW scrutinised the analyses, suggested further analyses and helped interpret some of the findings. All the authors were involved in revising the manuscript and gave final approval. JFG is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This study was funded by Essity Hygiene and Health AB, Mölndal, Sweden. The study’s sponsors had no involvement in the study design, the collection, analysis and interpretation of the data, the writing of this manuscript and the decision to submit this article for publication. The views expressed in this article are those of the authors, and not necessarily those of Essity Hygiene and Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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