Thi Anh Thu Le, Thi Hong Thoa Vo, Thi Van Trang Dang, Phuc Tien Nguyen, Thuy Van Dang, Thi Kim Anh Le, Wertheim Heiman F L, Truong Son Nguyen
Cho Ray Hospital, Ho Chi Minh City, Vietnam.
Cho Ray Hospital, Ho Chi Minh City, Vietnam.
Am J Infect Control. 2015 Dec 1;43(12):e93-9. doi: 10.1016/j.ajic.2015.08.006. Epub 2015 Oct 1.
The cost-effectiveness of a hand hygiene (HH) program in low- and middle-income countries (LMICs) is largely unknown. We assessed the cost-effectiveness of a HH program in a large tertiary Vietnamese hospital.
This was a before and after study of a hand hygiene program where HH compliance, incidence of hospital-acquired infections (HAIs), and costs were analyzed.The HH program was implemented in 2 intensive care and 15 critical care units. The program included upgrading HH facilities, providing alcohol-based handrub at point of care, HH campaigns, and continuous HH education.
The HH compliance rate increased from 25.7% to 57.5% (P < .001). The incidence of patients with HAI decreased from 31.7% to 20.3% (P < .001) after the intervention. The mean cost for patients with HAI was $1,908, which was 2.5 times higher than the costs for patients without an HAI. The mean attributable cost of an HAI was $1,131. The total cost of the HH program was $12,570, which equates to a per-patient cost of $6.5. The cost-effectiveness was estimated at -$1,074 or $1,074 saved per HAI prevented. The intervention remained cost savings under various scenarios with lower HAI rates.
The HH program is an effective strategy in reducing the incidence of HAIs in intensive care units and is cost-effective in Vietnam. HH programs need to be encouraged across Vietnam and other LMICs.
低收入和中等收入国家（LMICs）手部卫生（HH）项目的成本效益在很大程度上尚不清楚。我们评估了越南一家大型三级医院手部卫生项目的成本效益。
这是一项关于手部卫生项目的前后对照研究，分析了手部卫生依从性、医院获得性感染（HAIs）发生率和成本。手部卫生项目在2个重症监护病房和15个危重症监护病房实施。该项目包括升级手部卫生设施、在护理点提供酒精洗手液、开展手部卫生宣传活动以及持续的手部卫生教育。
手部卫生依从率从25.7%提高到57.5%（P <.001）。干预后，医院获得性感染患者的发生率从31.7%降至20.3%（P <.001）。医院获得性感染患者的平均成本为1908美元，比未发生医院获得性感染的患者成本高2.5倍。医院获得性感染的平均归因成本为1131美元。手部卫生项目的总成本为12570美元，相当于每位患者6.5美元的成本。估计成本效益为-1074美元，即每预防一例医院获得性感染节省1074美元。在医院获得性感染率较低的各种情况下进行干预仍能节省成本。
手部卫生项目是降低重症监护病房医院获得性感染发生率有效策略，在越南具有成本效益。越南和其他低收入和中等收入国家应鼓励开展手部卫生项目。
