No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Evaluating the economics of the Australian National Hand Hygiene Initiative
Abstract
The National Hand Hygiene Initiative, implemented in Australia in 2009, is currently being evaluated for effectiveness and cost-effectiveness by a multidisciplinary team of researchers. Data from a wide range of sources are being harvested to address the research questions. The data are observational and appropriate statistical and economic modelling methods are being used. Decision makers will be provided with new knowledge about how hand hygiene interventions should be organised and what investment decisions are justified. This is novel research and the authors are unaware of any other evaluation of hand hygiene improvement initiatives. This paper describes the evaluation currently underway.
... As neither study was a clinical trial, a mutual acceptance process was not available. Complete details on both studies are available in their protocol papers [6,7]. ...
... The costs were particularly high for the National Hand Hygiene Evaluation which covered 50 hospitals across 8 states and territories and needed 38 % of the budget, whereas the REACH Trial with 11 hospitals across 7 states and territories needed 2 % of the budget. Both studies were mostly low risk; high risk multi-centre studies could expect higher costs and longer delays [7]. Most of our staff members had experience with ethics applications, and studies using less experienced staff would likely experience longer delays. ...
Background
Multi-centre studies generally cost more than single-centre studies because of larger sample sizes and the need for multiple ethical approvals. Multi-centre studies include clinical trials, clinical quality registries, observational studies and implementation studies. We examined the costs of two large Australian multi-centre studies in obtaining ethical and site-specific approvals.
Methods
We collected data on staff time spent on approvals and expressed the overall cost as a percent of the total budget.
Results
The total costs of gaining approval were 38 % of the budget for a study of 50 centres (mean cost AUD 2300 per site). Seventy-five and 90 % of time was spent on repeated tasks, respectively, and many time-consuming tasks, such as reformatting documents, did nothing to improve the study design or participant safety.
Conclusions
Improvements have been made to the ethical approval application system, but more gains could be made without increasing risks of harm to research participants. We propose that ethical review bodies and individual sites publish statistics on how long they take to process approvals which could then be nationally benchmarked.
Introduction
Interventions that prevent healthcare-associated infections should lead to fewer deaths and shorter hospital stays. Cleaning hands with soap and water or alcohol rub is an effectiveway to prevent the transmission of organisms, but compliance is sometimes low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infections.
Methods
We examined if the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for six types of healthcare-associated infections were examined in 38 Australian hospitals across six states. Infection categories were: bloodstream infections, centralline associated bloodstream infections, methicillin-resistant and methicillin-sensitive Staphylococcus aureus, Staphylococcus aureus bacteraemia and surgical site infections.
Results
The National Hand Hygiene Initiative was associated with a statistically significant reduction in infection rates in 11 out of 23 state and infection combinations studied. There was no change in infection rates for nine combinations, and there was an increase in three infection rates in South Australia.
Conclusions
The intervention was associated with reduced infection rates in many cases. The lack of improvement in nine cases may have been because they already had effective initiatives before the national initiative's introduction.
Healthcare settings are dangerous places. For those receiving care, the risk of unintended harm from healthcare failures continues to be significant. Given this, there is a need to monitor standards in healthcare, not only to identify potential issues, but also to plan and evaluate interventions aimed at improving healthcare standards. Public reporting of performance standards is one aspect to monitoring standards, but not the only one. Public reporting also brings with it challenges. This perspective explores the recent move to publicly report one healthcare-associated infection (HAI) on the MyHospitals website and comments on the broader issue of using existing HAI data for the purposes of public reporting.
Implementing a hand hygiene program nationally requires a culture change.
To present a hypothetical model of the change in economic costs and health benefits to society that result from nosocomial infection control programs.
We use a modeling framework to represent how 2 types of costs change with nosocomial infection control programs: costs incurred by the hospital sector and community health services, as well as the private costs to patients. We also demonstrate how to value the health benefits of nosocomial infection control programs, using quality-adjusted life years.
Hypothetical modeling to incorporate the societal perspective.
A cohort of 50,000 simulated patients at risk of surgical site infection following total hip replacement.
A total of 8 hypothetical interventions that change costs and health outcomes among the cohort by preventing cases of surgical site infection following total hip replacement.
We demonstrate that when infection control interventions reduce economic costs and increase health benefits, they should be adopted without further question. If, however, interventions increase economic costs and increase health benefits, then the trade-off between costs and benefits should be examined. Decision-makers should assess the cost per unit of health benefit from infection control programs, consider the impact on health budgets, and compare infection control with alternative uses of scarce healthcare resources.
To quantify the evidence for infection-control interventions among high-risk cancer patients and haematopoietic stem-cell recipients, we did a systematic review of prospective comparative studies. Protective isolation, including air quality control, prophylactic antibiotics, and barrier isolation (29 studies), brought about a significant reduction in all-cause mortality: risk ratio 0.60 (95% CI 0.50-0.72) at 30 days (number needed to treat [NNT] 20 [95% CI 14-33]) and 0.86 (95% CI 0.81-0.91) at the longest follow-up (up to 3 years; NNT 12 [95% CI 9-20]). Inclusion of prophylactic antibiotics in the intervention was necessary to show the effect on mortality. The combined intervention reduced bacteraemia, and Gram-negative, Gram-positive, and Candida spp infections. Mould infections were not significantly reduced. 11 non-randomised prospective studies assessed inpatient versus outpatient management after autologous stem-cell transplantation. All-cause mortality was lower among outpatients: risk ratio 0.72 [95% CI 0.55-0.95]. We conclude that prophylactic antibiotics are the most effective treatment within the protective environment. Randomised trials on outpatient management of haematological cancer patients are needed.