Hand hygiene.pdf

Annual hand hygiene product budgets at other institutions vary considerably because of
differences in usage patterns and varying product prices. Countries/states/regions/localities
with centralized purchasing can achieve economies on a scale that can result in considerable
cost reduction of products. A recent cost comparison of surgical scrubbing with an
antimicrobial soap versus brushless scrubbing with an alcohol-based handrub revealed that
costs and time required for preoperative scrubbing were less with the alcohol-based product
255. In a trial conducted in two ICUs, Larson and colleagues 256 found that the cost of
using an alcohol-based handrub was half that of using an antimicrobial soap for handwashing
(US$ 0.025 versus US$ 0.05 per application, respectively). In another study conducted
in two neonatal ICUs, investigators looked at the costs of a traditional handwashing regimen
using soap, use of an alcohol-based handrub supplemented by a non-antimicrobial soap,
use of hand lotion, and nursing time required for hand hygiene 497 . Although product costs
were higher when the alcohol-based handrub was used, the overall cost of hand hygiene
was lower with the handrub because it required less nursing time.
To assess the cost–effectiveness of hand hygiene programmes, it is necessary to consider
the potential cost savings that can be achieved by reducing the incidence of HCAIs.
The excess hospital costs associated with only four or five HCAIs of average severity may
equal the entire annual budget for hand hygiene products used in inpatient care areas.
Just one severe surgical site infection, lower respiratory infection, or bloodstream infection
may cost the hospital more than the entire annual budget for antiseptic agents used for
hand hygiene 362 . For example, in a study conducted in a Russian neonatal ICU, the authors
estimated that the excess cost of one health care-associated bloodstream infection (US$
1100) would cover 3265 patient-days of hand antiseptic use (US$ 0.34 per patient-day) 529 .
The authors estimated that the alcohol-based handrub would be cost effective if its use
prevented approximately 3.5 bloodstream infections per year or 8.5 pneumonias per year.
In another study, it was estimated that cost savings achieved by reducing the incidence of
C. difficile-associated disease and MRSA infections far exceeded the additional cost of using
an alcohol-based handrub 592 .
Several studies provided some quantitative estimates of the cost–effectiveness of hand
hygiene promotion programmes 119,262 . Webster and colleagues 119 reported a cost saving
of approximately US$ 17 000 resulting from reduced use of vancomycin following the
observed decrease in MRSA incidence in a seven-month period. Similarly, MacDonald and
colleagues reported that the use of an alcohol-based hand gel combined with education
sessions and performance feedback to HCWs reduced the incidence of MRSA infections
and expenditures for teicoplanin (used to treat such infections) 363 . For every £1 spent on
alcohol-based gel, £9–20 were saved on teicoplanin expenditure.
Including both direct costs associated with the intervention (increased use of handrub
solution, poster reproduction and implementation) and indirect costs associated with HCW
time, Pittet and colleagues 262 estimated the costs of the programme to be less than US$
57 000 per year for a 2600-bed hospital, an average of US$ 1.42 per patient admitted.
Supplementary costs associated with the increased use of alcohol-based handrub solution
averaged US$ 6.07 per 100 patient-days. Based on conservative estimates of US$ 100 saved
per infection averted, and assuming that only 25% of the observed reduction in the infection
rate has been associated with improved hand hygiene practice, the programme was largely
cost effective. A subsequent follow-up study performed in the same instititution determined
the direct costs of the alcohol-based handrub used, other direct costs, indirect costs for hand
hygiene promotion, and the annual prevalence of HCAI for 1994 to 2001 364 . Total costs for
the hand hygiene programme averaged Swiss francs (CHF) 131 988 between 1995 and 2001,
or about CHF 3.29 per admission. The prevalence of HCAI decreased from 16.9 per 100