Umbrella review of economic evaluations of interventions for the prevention and management of healthcare-associated infections in adult hospital patients

Abstract

Background: Healthcare-associated infections (HCAIs) result in worse outcomes for patients and greater financial burden. An estimated 4.8 million HCAIs occurred in hospitals across Europe in 2022-23. Sixty-four percent of antibiotic-resistant infections in Europe are associated with healthcare. It is therefore vital to identify cost-effective interventions.

Aim: To summarize the cost-effectiveness evidence of interventions addressing HCAIs in hospitals.

Methods: An umbrella review was conducted to identify evidence on the cost-effectiveness of antimicrobial stewardship, infection prevention and control, and microbiology and diagnostic stewardship interventions for the prevention and clinical management of HCAIs in adult hospital patients. Medline, Embase, and EconLit databases were searched. A qualitative synthesis was undertaken.

Findings: Twenty-four systematic reviews met the inclusion criteria, with 101 separate analyses extracted and grouped into 10 intervention and 14 infection/organism categories, across various countries and settings. Most evidence focused on screening followed by contact precautions, isolation and/or decolonization, with selective screening most cost-effective. Most infection prevention and control bundles were cost-effective, although interventions were heterogeneous. The evidence base was sparse for the remaining intervention categories, with more research required. The limited evidence suggests that standalone environmental cleaning, hand hygiene, diagnostics, surveillance, antimicrobial stewardship, and decolonization interventions were mostly cost-effective. The cost-effectiveness of standalone personal protective equipment, and education and training interventions was mixed. Most interventions focused on meticillin-resistant Staphylococcus aureus and other Gram-positive infections, with more research needed on Gram-negative infections. The comparator was unclear in many extracted analyses.

Conclusions: Cost-effective interventions to address HCAIs in hospitals exist, although more evidence is needed for most interventions.

Keywords: Antimicrobial resistance; Antimicrobial stewardship; Cost-effectiveness; Healthcare-associated infection; Infection prevention and control; Microbiology and diagnostic stewardship; Umbrella review.