Modelling the costs and consequences of reducing healthcare-associated infections by improving hand hygiene in an average hospital in England
Modelling the costs and consequences of reducing healthcare-associated infections by improving hand hygiene in an average hospital in England
复制标题
DOI：
10.1136/bmjopen-2019-029971
复制
发表时间：
2019-10-01
期刊：
影响因子：
2.9
通讯作者：
Wigglesworth, Neil
中科院分区：
文献类型：
--
作者：
Guest, Julian F.;Keating, Tomas;Wigglesworth, Neil
目的评估在英国一家假设的综合医院中引入电子审计和反馈系统以提高手卫生依从性的潜在临床和经济影响，方法决策分析评估了在当前实践中引入电子审计和反馈系统以提高前线人员手部卫生依从性的影响，结果该模型假设4.7%的成人住院患者（即≥ 18岁）和1.72%的一线医护人员在当前实践中获得HCAI。该模型估计，如果使用电子审计和反馈系统可以导致HCAIs的发生率降低5%至25%，那么每年避免的HCAIs数量可能在每家医院184至921例感染之间，HCAIs相关死亡率可能在每家医院每年6至31例死亡之间。此外，前线医护人员最多可避免86天缺勤，最多可腾出7794个医院病床日供其他用途。因此，HCAIs每年的总医院成本可以减少3%至23%，这取决于电子审计和反馈系统的有效性。如果在当前实践中引入电子审计和反馈系统可以导致HCAIs的发生率减少至少15%，它将有>= 0.75的概率为国民保健服务（NHS）提供成本-结论在英国一家假设的综合医院中，如果将电子审计和反馈系统引入目前的实践，一线HCP的依从性导致HCAIs的发生率降低>= 15%，这可能会为NHS提供一种具有成本效益的干预措施。
Objective To assess the potential clinical and economic impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance in a hypothetical general hospital in England, to reduce the incidence of healthcare-associated infections (HCAIs).Methods Decision analysis estimated the impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance among front-line healthcare practitioners (HCPs).Results The model assumed 4.7% of adult inpatients (ie, >= 18 years of age) and 1.72% of front-line HCPs acquire a HCAI in current practice. The model estimated that if use of the electronic audit and feedback system could lead to a reduction in the incidence of HCAIs of between 5% and 25%, then the annual number of HCAIs avoided could range between 184 and 921 infections per hospital and HCAI-related mortality could range between 6 and 31 deaths per annum per hospital. Additionally, up to 86 days of absence among front-line HCPs could be avoided and up to 7794 hospital bed days could be released for alternative use. Accordingly, the total annual hospital cost attributable to HCAIs could be reduced by between 3% and 23%, depending on the effectiveness of the electronic audit and feedback system. If introduction of the electronic audit and feedback system into current practice could lead to a reduction in the incidence of HCAIs by at least 15%, it would have a >= 0.75 probability of affording the National Health Service (NHS) a cost-effective intervention.Conclusion If the introduction of the electronic audit and feedback system into current practice in a hypothetical general hospital in England can improve hand hygiene compliance among front-line HCPs leading to a reduction in the incidence of HCAIs by >= 15%, it would potentially afford the NHS a cost-effective intervention.