Cost Analysis of a Hand Hygiene Improvement Strategy in Long-Term Care Facilities

Objectives To evaluate whether the costs of a successful tailored multifaceted strategy to improve hand hygiene compliance outweighed the savings by reducing infection costs in Dutch long-term care facilities (LTCFs). Design A retrospective cost analysis alongside a stepped-wedge cluster-randomized controlled trial. Setting and Participants The study included 14 LTCFs (23 wards) in the Netherlands. Methods The cost analysis was based on the costs of the intervention vs the savings from avoided infections and associated treatment costs. Infection-related costs of the “usual-care” period were compared with the combined infection-related costs and intervention costs from the “intervention” period and the costs in the “post-intervention period.” Multilevel analyses, with a linear model with periods as fixed effects, random effects for cluster LTCFs, and fixed effects for each step, were completed. Results There are no significant differences in total costs considering the 3 periods. When adjusting for time and clustering, the mean infection-related costs per week per LTCF for all the infections combined were highest during “usual-care” before the hand hygiene intervention was performed, namely 680 euros per week. Assuming the effect of the improvement strategy would be present for 12 months, the costs per week in the “intervention” and “post-intervention” periods were 627 euros (95% CI, 383–871) and 731 euros (95% CI, 508–954), respectively. Assuming the effect of the improvement strategy will last longer than 1 year (ie, 18 and 24 months), the average cost for the “intervention period” and the “post-intervention” period decreased to 615 euros and 719 euros during the intervention and 609 euros and 715 euros after the intervention, respectively. Conclusions and Implications Our multifaceted hand hygiene improvement strategy achieves cost savings. The results of our study are the first of an economic analysis of a hand hygiene improvement strategy in LTCFs. The results need to be confirmed by further economic evaluations.