Economics Division, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Legon, Accra, Ghana.
Department of Public Health, Aarhus University, Aarhus, Denmark.
PLoS One. 2022 Mar 4;17(3):e0264905. doi: 10.1371/journal.pone.0264905. eCollection 2022.
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.
基于酒精的洗手液（ABH）预防新生儿血流感染（BSI）的成本效益在撒哈拉以南非洲地区的证据有限。因此，本研究使用 HAI-Ghana 研究的数据，评估在加纳新生儿重症监护病房（NICU）环境中，使用包含 ABH 的多模式手卫生措施预防新生儿 BSI 的成本效益。设计为干预前后研究，使用经济评估模型评估包含 ABH 加肥皂和水的多模式手卫生策略与仅使用肥皂和水的现有实践相比的成本效益。我们通过从干预后的结果中减去没有干预的结果来衡量效果和成本。主要结果测量是通过干预避免的新生儿 BSI 发作数量以及从患者和提供者角度节省的成本。干预前后的研究分别持续四个月，分别为 2017 年 10 月至 2018 年 1 月和 2018 年 12 月至 2019 年 3 月。分析表明，ABH 方案有效降低了新生儿 BSI 的患者成本 41.7%，BSI 相关医院成本 48.5%。此外，新生儿 BSI 相关死亡和额外住院时间（LOS）分别减少了 73%和 50%。此外，干预后的评估显示，ABH 方案使 NICU 新生儿 BSI 的发病率降低了 16%。该干预措施是一种简单且适应性强的策略，如果在全国范围内谨慎推广，具有节省成本的潜力。尽管干预措施的成本可能相对较高，因为仅使用肥皂和水进行手部卫生，但从患者和提供者的角度来看，干预措施可以有效降低新生儿 BSI 的发病率和相关成本，这是投资干预措施的一个很好的理由。
