Abstract
Published evidence of the cost-effectiveness of alcohol-based handrub (ABH) for the prevention of neonatal bloodstream infections (BSI) is limited in sub-Saharan Africa. Therefore, this study evaluates the cost-effectiveness of a multimodal hand hygiene involving alcohol-based hand rub (ABH) for the prevention of neonatal BSI in a neonatal intensive care unit (NICU) setting in Ghana using data from HAI-Ghana study. Design was a before and after intervention study using economic evaluation model to assess the cost-effectiveness of a multimodal hand hygiene strategy involving alcohol-based hand rub plus soap and water compared to existing practice of using only soap and water. We measured effect and cost by subtracting outcomes without the intervention from outcomes with the intervention. The primary outcome measure is the number of neonatal BSI episode averted with the intervention and the consequent cost savings from patient and provider perspectives. The before and after intervention studies lasted four months each, spanning October 2017 to January 2018 and December 2018 to March 2019, respectively. The analysis shows that the ABH program was effective in reducing patient cost of neonatal BSI by 41.7% and BSI-attributable hospital cost by 48.5%. Further, neonatal BSI-attributable deaths and extra length of hospital stay (LOS) decreased by 73% and 50% respectively. Also, the post-intervention assessment revealed the ABH program contributed to 16% decline in the incidence of neonatal BSI at the NICU. The intervention is a simple and adaptable strategy with cost-saving potential when carefully scaled up across the country. Though the cost of the intervention may be more relative to using just soap and water for hand hygiene, the outcome is a good reason for investment into the intervention to reduce the incidence of neonatal BSI and the associated costs from patient and providers’ perspectives.
Highlights
The health and economic impact of hospital-acquired neonatal bloodstream infection (BSI) is enormous but often underestimated due to data constraints resulting from a lack of monitoring and reporting from hospital settings [1]
The neonatal intensive care unit (NICU) is managed by the Department of Child Health and has in place an Infection Prevention and Control (IPC) team managed by the Quality Assurance Unit of the hospital
The incidence of neonatal BSI was 28% [95% CI: 23%–33%%] and 17.9% [95% CI: 14%–21%] in the pre and post intervention groups respectively
Summary
The health and economic impact of hospital-acquired neonatal bloodstream infection (BSI) is enormous but often underestimated due to data constraints resulting from a lack of monitoring and reporting from hospital settings [1]. A global estimate of the burden of BSI shows that approximately 3 million neonates suffer the condition annually [1], of which an estimated 25% or more die [2]. In terms of the economic burden, the annual value of statistical life measured as the disability-adjusted life years (DALY) attributable to neonatal BSI in SSA range between $10 billion and 469 billion [2]. The capacity of neonatal intensive care units (NICU) in under-resourced countries is overstretched due to about 10–15% incidence of hospital-acquired infections (HAI) rate among neonates [3, 4], and the corresponding prolong length of hospital stay (LOS) for treatment of the health condition. The burden of BSI in low and middle-income countries is compounded by limited access to fully-functional laboratories required to enhance early diagnosis and treatment of neonatal sepsis [5]
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