A Bundled
Approach to
Improving
Environmental
Hygiene is
Cost Effective
for HAI
Reduction
By Kelly M. Pyrek
H
ospital environmental
hygiene expert Jon
This is the
Otter, PhD FRCPath, of
second in a
Imperial College London,
two-part series
says that while “there
examining the
is now strong data that
clinical and
cleaning and disinfection
fiscal aspects
is effective in improving
of making
patient outcomes, there is
the case for
limited cost-effectiveness
environmental
data.” He points to a
hygiene.
2009 study from the UK
showing that the addition
of one environmental services professional
reduced MRSA infections by 27 percent and
saved between £30,000 and £70,000. As Otter
notes, “The caveat here is that it can be difficult
to work out exactly where ‘savings’ from reduced
HAIs appear in hospital finances, since they are
a mixture of reduced fixed and variable costs.”
(Otter, 2018)
A recent study evaluated the cost-effectiveness
of an environmental cleaning bundle for reducing
the incidence of healthcare-acquired infections
(HAIs), indicating that there is a strong business
case to be made for environmental hygiene.
Through the Researching Effective Approaches
to Cleaning in Hospitals (REACH) study, research-
ers in Australia implemented in 11 hospitals an
environmental cleaning bundle that comprised
targeted communication, staff training, improved
cleaning technique, product use, and audit of
frequent touch-point cleaning.
According to the researchers, the intervention
was associated with a decrease in Staphylococcus
aureus bacteremia (SAB) and VRE infection rates,
Editor’s note
20
with a combined 40 infections prevented over
approximately 1.3 million occupied bed days.
Bundle effectiveness estimates were larger for SAB
(23.5 infections prevented) compared with VRE
(16.0 infections prevented); insufficient evidence
of effectiveness on CDI rates led to its exclusion
from subsequent analysis. Infections prevented
under the intervention resulted in a combined
gain of 43 quality-adjusted life-years (QALYs).
In the study, White, et al. (2019) defined
changes to costs as the cost of implementing
the bundle minus cost savings from fewer
infections. As we have seen, health benefits
gained from fewer infections were measured
in 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. Implementing the cleaning bundle cost
$349,000 Australian dollars (AUD) and gener-
ated 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 $4,684
per QALY gained. There was an 86 percent chance
that the bundle was cost-effective compared with
existing hospital cleaning practices.
Study co-author Brett Mitchell, of the Institute
of Health and Biomedical Innovation, Queensland
University of Technology, says the cost savings
were significant enough for the average hospital
leader to be convinced to adopt this kind of a
bundle. “Most interventions in healthcare and
hospital cost money,” he says. “There is, of
course, a return on that investment, by way of
improvements to health.”
A recent study
evaluated
the cost-
effectiveness
of an
environmental
cleaning
bundle for
reducing the
incidence of
healthcare-
acquired
infections
(HAIs),
indicating
that there
is a strong
business case
to be made for
environmental
hygiene.
february 2020 • www.healthcarehygienemagazine.com