Stephen Rice, MSc

Credit: Research Gate

While there is some evidence that hand hygiene, environmental cleaning, surveillance, and multimodal interventions are effective in reducing hospital acquired infections, more research is needed on other potential mitigation options.¹

A team, led by Stephen Rice, MSc, Population Health Sciences Institute, Newcastle University, reviewed the cost effectiveness of interventions that limit the spread of health acre associated infections.

“This review provides a map of cost-effectiveness data, so that policy makers and researchers can identify the relevant data and then assess the quality and generalizability for their setting,” the authors wrote.

A Growing Problem

Every year nearly 9 million health care-associated infections occur in European hospitals and long-term care facilities. This has led to an increase in morbidity, mortality, bed occupancy, and longer hospital stays.

In the study, the investigators used World Health Organization (WHO) infection prevention and control core components and searched various databases and grey literature for studies on interventions such as hand hygiene, personal protective equipment, national-level or facility-level infection prevention and control programs, education and tr4aining programs, environmental cleaning, and surveillance between January 1, 2009 and August 10, 2022.

The team assessed the quality of economic evaluations using the British Medical Journal checklist and identified 67 studies, 25 of which evaluated methicillin-resistant Staphylococcus aureus outcomes and 31 that evaluated screening strategies.

The studies that met the minimum quality criteria consisted of economic models.

“There was some evidence that hand hygiene, environmental cleaning, surveillance, and multimodal interventions were cost-effective,” the authors wrote. “There were few or no studies investigating education and training, personal protective equipment or monitoring, and evaluation of interventions.”

Recent Data

Mitigation measures and a reduction in patients may have had an impact on some hospital-acquired infections during the COVID-19 pandemic, while other infections may have increased.

A team, led by Martin E. Evans, MD, National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, assessed how the COVID-19 pandemic impacted healthcare-associated infections in 128 acute care and 132 long-term care Veterans Affairs facilities.

The data shows admissions to the nationwide VA for COVID-19 infections peaked in January 2021, resulting in significant increases in CLABSIs, VAEs, and MRSA all-site hospital-acquired infections at acute care facilities during the pandemic.

However, there was no significant changes in CAUTI rates, while C difficile infection rates significantly decreased.

Other research has corroborated the fact that new hospitals could result in a steep drop in hospital-acquired infections, particularly for C difficile infections.

References:

Rice, S., Carr, K., Sobiesuo, P., Shabaninejad, H., Orozco-Leal, G., Kontogiannis, V., Marshall, C., Pearson, F., Moradi, N., O'Connor, N., Stoniute, A., Richmond, C., Craig, D., Allegranzi, B., & Cassini, A. (2023). Economic evaluations of interventions to prevent and control health-care-associated infections: A systematic review. The Lancet Infectious Diseases. https://doi.org/10.1016/s1473-3099(22)00877-5