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Randomized Controlled Trial
. 2025 Apr 1;8(4):e258565.
doi: 10.1001/jamanetworkopen.2025.8565.

Economic Evaluation of Enhanced Cleaning and Disinfection of Shared Medical Equipment

David Brain  1 , Nirmali Sivapragasam  1 , Katrina Browne  2 , Nicole M White  1 , Philip L Russo  2   3   4 , Allen C Cheng  5 , Andrew J Stewardson  6 , Georgia Matterson  2 , Peta E Tehan  2   7 , Kirsty Graham  8 , Maham Amin  8 , Martin Kiernan  2   9 , Jennie King  8   10 , Brett G Mitchell  8   11
Affiliations
Randomized Controlled Trial

Economic Evaluation of Enhanced Cleaning and Disinfection of Shared Medical Equipment

David Brain et al. JAMA Netw Open. .

Abstract

Importance: The economic value of cleaning and disinfection of shared medical equipment is currently unknown.

Objective: To evaluate whether or not better environmental cleaning and disinfection of shared medical equipment would be cost-effective compared with usual care.

Design, setting, and participants: This economic evaluation study was a within-trial cost-effectiveness analysis of a stepped-wedge cluster randomized clinical trial: the Cleaning and Enhanced Disinfection (CLEEN) study. The trial included 5002 inpatients and was conducted in 10 adult acute-care wards at a tertiary hospital in Australia between March 20, 2023, and November 24, 2023. The evaluation takes a hospital costing perspective. A decision-tree model was developed to evaluate the intervention; costs are presented in Australian dollars. Statistical analysis was performed from May to October 2024.

Interventions: A multimodal cleaning intervention was introduced during the intervention, focusing on additional cleaning hours, education, audit, and feedback. The control group received usual care, including routine cleaning by clinical staff.

Main outcomes and measures: Incremental cost-effectiveness ratio, where the mean change to costs associated with the intervention is divided by the mean change in outcomes.

Results: This study assessed 5002 patients (2478 [49.5%] male, 2524 [50.5%] female [50.5%]; mean [SD] age, 71.6 [16.1] years). For a cohort of 1000 patients at risk of health care-associated infection (HAI), the estimated total costs associated with the intervention were $1 513 300, compared with $2 155 310 for usual care. The estimated number of HAIs was 100 in the intervention group, compared with 130 for the usual care group. Compared with usual care, the intervention was associated with reduced HAIs and costs, with a 90.5% chance that intervention adoption was cost-saving. This probability increased to 99.9% if a decision-maker was willing to pay $20 000 to avoid an infection.

Conclusions and relevance: In this economic evaluation study of enhanced cleaning and disinfection of shared medical equipment, the intervention resulted in reduced HAIs and a $642 010 reduction in costs per 1000 patients, compared with the control group. These results suggest that the CLEEN intervention is a cost-saving initiative.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Cheng reported grants from National Health and Medical Research Council (NHMRC) outside the submitted work. Dr Tehan reported grants from the Urgo Foundation, the Australian Podiatry Association, the Department of Health and Aged Care, Wounds Australia, and the Australian Podiatry Education Research Foundation outside of the submitted work. Mr Kiernan reported personal fees from GAMA Healthcare outside the submitted work. Prof Mitchell reported grants from GAMA Healthcare Australia (funds paid to institution) outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Decision-Tree for Possible Paths of Movement for Patients
The usual care branches of the tree are the same as the intervention group (ie, include the same infections). They are omitted from this decision-tree to help reduce complexity and aid visual interpretation. BSI indicates bloodstream infection; EENT, ear, eye, nose, mouth, and throat infection; GI, gastrointestinal infection; GI-CDI, gastrointestinal infection – Clostridioides difficile; LRI, lower respiratory infection; PN, pneumonia; SSI, surgical site infection; UTI, urinary tract infection. Other included cardiovascular system infection, EENT, skin or soft tissue, and systematic infection.
Figure 2.
Figure 2.. Heatmap Showing Distribution of Incremental Cost-Effectiveness Ratios From the Probabilistic Sensitivity Analysis
The blue square is the mean of the incremental cost-effectiveness ratios from the probabilistic sensitivity analysis.
See this image and copyright information in PMC

References

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