title: Cost-effectiveness of a hand hygiene program on health care-associated infections in intensive care patients at a tertiary care hospital in Vietnam.
abstract: BACKGROUND
  The cost-effectiveness of a hand hygiene (HH) program in low- and middle-income countries (LMICs) is largely unknown. We assessed the cost-effectiveness of a HH program in a large tertiary Vietnamese hospital.
  
  
  METHODS
  This was a before and after study of a hand hygiene program where HH compliance, incidence of hospital-acquired infections (HAIs), and costs were analyzed.The HH program was implemented in 2 intensive care and 15 critical care units. The program included upgrading HH facilities, providing alcohol-based handrub at point of care, HH campaigns, and continuous HH education.
  
  
  RESULTS
  The HH compliance rate increased from 25.7% to 57.5% (P < .001). The incidence of patients with HAI decreased from 31.7% to 20.3% (P < .001) after the intervention. The mean cost for patients with HAI was $1,908, which was 2.5 times higher than the costs for patients without an HAI. The mean attributable cost of an HAI was $1,131. The total cost of the HH program was $12,570, which equates to a per-patient cost of $6.5. The cost-effectiveness was estimated at -$1,074 or $1,074 saved per HAI prevented. The intervention remained cost savings under various scenarios with lower HAI rates.
  
  
  CONCLUSIONS
  The HH program is an effective strategy in reducing the incidence of HAIs in intensive care units and is cost-effective in Vietnam. HH programs need to be encouraged across Vietnam and other LMICs.
authors.affiliation: Cho Ray Hospital, Ho Chi Minh City, Vietnam. Electronic address: letathu@gmail.com.
authors.forename: Le
authors.initials: L
authors.lastname: Thi Anh Thu
authors.affiliation: Cho Ray Hospital, Ho Chi Minh City, Vietnam.
authors.forename: Vo
authors.initials: V
authors.lastname: Thi Hong Thoa
authors.affiliation: Cho Ray Hospital, Ho Chi Minh City, Vietnam.
authors.forename: Dang
authors.initials: D
authors.lastname: Thi Van Trang
authors.affiliation: Cho Ray Hospital, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Phuc Tien
authors.affiliation: Cho Ray Hospital, Ho Chi Minh City, Vietnam.
authors.forename: Dang
authors.initials: D
authors.lastname: Thuy Van
authors.affiliation: Cho Ray Hospital, Ho Chi Minh City, Vietnam.
authors.forename: Le
authors.initials: L
authors.lastname: Thi Kim Anh
authors.affiliation: Oxford University Clinical Research Unit, Hanoi, Vietnam, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Department of Clinical Microbiology, Radboudumc, Nijmegen, the Netherlands.
authors.forename: Heiman F L
authors.initials: HF
authors.lastname: Wertheim
authors.affiliation: Cho Ray Hospital, Ho Chi Minh City, Vietnam.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Truong Son
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D063373:Hand Hygiene / Q000379:methods*; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000191:economics* / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D062606:Tertiary Care Centers; D014744:Vietnam / Q000453:epidemiology
keywords: Antibiotic resistance; Cost-effectiveness; Hand hygiene; Hospital-acquired infection; Low- and middle-income country; Vietnam