He continues, “In Australia, there is generally
a willingness to pay a threshold of AUD$28,000
per QALY. Findings from our study indicated that
the cost of investing in cleaning is much lower
than this. So, comparable to other interventions,
you get a good ‘bang for your buck.’ For this
reason, I would expect that CEOs see the value
in investing in cleaning.”
“Generally, hospital executives from the
11 participating hospitals were pleased when
presented with the overall results of the study,”
confirms co-author Alison Farrington, research
project manager for AusHSI, the Australian Centre
for Health Services Innovation.
“Our estimation of cost savings was limited
to the duration of the trial (62 weeks),” explains
lead author Nicole White, of the Institute of
Health and Biomedical Innovation, Queensland
University of Technology. “We did not explicitly
consider savings beyond this timeframe, however
this would be influenced by long-term adherence
to the bundle and associated costs required to
maintain long-term adherence (e.g., ongoing
training for current and new staff). A key driver
of cost savings in our analysis was the value of
hospital bed days released from fewer patients
acquiring a SAB or VRE infection. This was based
on an Australian CEO’s willingness to pay for
a hospital bed day and may vary in different
healthcare settings.”
The researchers note that, “Pragmatic imple-
mentation of the bundle in real-world hospital
settings combined with prospective data collection
under a stepped-wedge design produced
high-quality evidence that the bundle would be
cost-effective if implemented elsewhere in similar
hospitals for reducing healthcare-associated SAB
and VRE infections.”
When it comes to U.S. hospital leadership
realizing similar cost savings, White observes,
“A pragmatic approach to implementation refers
to the tailoring of bundle activities to individ-
ual hospitals, based on their current cleaning
practices and the changes required to meet
best-practice recommendations. Our evidence
for the cost-effectiveness of the bundle therefore
reflects the incremental value of adopting the
bundle compared with existing infection control
measures. When evaluating this evidence, hospital
decision makers elsewhere would therefore need
to consider these results in the context of current
measures already in place at their hospital, in
addition to the changes required to align with the
bundle and current rates of SAB and VRE infection.
The cost and return on this investment will vary
due to these contextual factors.”
In their study, the researchers measured bundle
effectiveness by the numbers of Staphylococcus
aureus bacteremia, Clostridium difficile infection,
and vancomycin-resistant enterococci infections
prevented in the intervention phase based on es-
timated reductions in the relative risk of infection.
“We used these outcomes as these were data
were routinely collected by hospitals,” Mitchell
explains. “In addition, at the time of planning
the study and seeking funding some seven years
ago, these infections were of note for Australian
hospitals. Because we used a stepped wedge
design, each hospital acts as its own control.
Therefore, the design accounts for local factors
and potential confounders. This is one of the
strengths of using this type of study design,
when evaluating certain infection prevention and
control initiatives.”
According to the researchers, implement-
ing the cleaning bundle cost approximately
AUD$349,000, or AUD$2,430 per 10,000
occupied bed days during the intervention phase.
Changing disinfectant represented 34 percent
of total costs or AUD $823 per 10,000 occupied
bed days.
Pre-intervention audit activities and study-re-
lated implementation incurred similar costs;
however, their overall contribution was relatively
small, the researchers add, consuming 15 percent
of total costs. After accounting for differences
in occupied bed days, the expected per-hospital
costs of establishing and maintaining the cleaning
bundle were approximately AUD$4,960 and
AUD$29,400, respectively. The researchers report
that approximately one-third of savings were from
treatments avoided, with cost savings marginally
higher for SAB compared with VRE. Total savings
based on accounting values were higher, resulting
In their
study, the
researchers
measured
bundle
effectiveness
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.
A pragmatic approach to implementation refers to the tailoring
of bundle activities to individual hospitals, based on their current
cleaning practices and the changes required to meet best-practice
recommendations. —
Alison Farrington
www.healthcarehygienemagazine.com • february 2020
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