Hand Hygiene Australia – Cost effectiveness publication

[Michael Wishart]

[Posted on behalf of HHA – Moderator]

We welcome discussion regarding this paper, and more broadly of the National Hand Hygiene Initiative. The QUT study was a large and complex project with many issues that warrant discussion and comment. Some of our comments have been previously published (see Grayson ML. J Hosp Infect 89: 137). Wed like to contribute the following points to todays discussion on this list:

* The annual cost of the NHHI as assessed by this study reflects start-up rather than maintenance costs. The cost information used in this study is taken from the 2011-2012 financial year (Page et al. J Hosp Infect, 2014;88:141). HHAs budget, which represented 20% of the NHHI costs, was halved in the subsequent financial year of 2012-13 (on schedule) and has since remained at this lower level.

* Other changes have been made as this program matured. For example, the costing study pre-dates introduction of the HHCApp mobile tool. This was developed to reduce total auditing time requirements (by elimination of data entry), while also facilitating immediate feedback and minimising data entry errors. Surveyed hand hygiene auditors that have moved to mobile devices have estimated that this can reduce time spent on audits by up to 50% (we aim to publish). So the cost-effectiveness study no longer reflects current practice.

* The benefits of the NHHI are almost certainly under-estimated. This study only considered health and cost benefits of preventing one type of HAI: S. aureus bloodstream infections. This is because no national measures were available for other infection types or pathogens. But appropriate hand hygiene should have broader benefits, not only for other healthcare-associated infections but also to reduce the transmission of antimicrobial resistance. No assessment of patient suffering was included.

Despite these points, the summary finding of this QUT study was that the NHHI is cost-effective according to Australian standards: This is the first cost-effectiveness evaluation of a National Hand Hygiene Initiative and shows that overall the programme was cost effective with a cost per life year gained of $29,700.

The NHHI is unique both in Australia and globally. We believe that its successes have been the result of combining evidence-based interventions and strong collaboration between infection control professionals, jurisdictional authorities, HHA, the Australian Commission on Safety and Quality in Health Care, and other groups. But just as the program has evolved since the 2012 snapshot provided by this study, it should also continue to do so into the future. This discussion is one part of that process.

Andrew Stewardson, National Project Manager, Hand Hygiene Australia
Lindsay Grayson, Director, Hand Hygiene Australia

______________________________________________________________________
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[Glenys Harrington]

Hi Kelly,

I wonder about the validity of such audits in terms of the Hawthorn effect.

Wouldn’t it be more appropriated and less time consuming to assess
competency by doing just-in-time peer review on employment and bi-annually
or annually?

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Kelly Barton
effectiveness publication

While HH audits can be time consuming, I find them paling in comparison in
the time it takes to audit Aseptic Technique, where “moments” for our health
service can go for well over 30 minutes. I’m wondering how other health
services manage their Aseptic Technique audits. I can spend a whole day
auditing and only get 5-6 audits done.

Kelly

Kelly Barton

Infection Prevention & Control Officer

Monday- Friday

P Reduce, re-use, recycle. Please consider the environment before printing
this e-mail.

Of Michelle Bibby

Thank you Mary-Louise for your response re Graves et al study and the
variances.

The concerns of biased data reported for hand hygiene compliance is worth
noting and I too agree with your comments here.

Costs associated with the efforts to report HH data as required which
detracts from some of the critical day to day requirements of the IC nurse
need further review.

Thank you

Michelle

Michelle Bibby

Infection Prevention Australia

Michelle@infectionprevention.com.au

+429071165

Dear Ramon and Glenys

Graves et al study relies on the accuracy of the 2 pivotal variables: SAB
and hand hygiene compliance. The accuracy of the latter is serious limited.
Our report in the Medical Journal of Australia (Med J Aust 2014; 200
(9):534-537.
http://dx.doi.org/10.5694/mja13.11203) concluded the HHA program reports
rates that have been biased upwards by very few high performers.

The conclusion from our findings and Graves et al is:

(1) SAB respond to multiple interventions and hand hygiene is only one of
these.

(2) hygiene compliance rates have not reached a tipping point to reduce SAB
and this tipping point is a long way off because

(3) the hand hygiene compliance rates are inaccurate.

It is important to have a national HH program. But the expense of the
current program is too high when the cost of audits provides flawed data
that reinforces a misguided belief that our hospitals are performing HH
well.

Mary-Louise

Professor Mary-Louise McLaws

Professor of Epidemiology in Healthcare Infection and Infectious Diseases
Control

http://research.unsw.edu.au/people/professor-marylouise-mclaws

SPHCM SAMUELS BUILDING

UNSW AUSTRALIA, SYDNEY NSW 2052 AUSTRALIA

CRICOS Provider Code 00098G

_____

Professor Ramon Shaban, ACIPC President [president@ACIPC.ORG.AU]

Colleagues

The study by Graves et al. reports a range of interesting findings, and
raises many issues regarding hand hygiene for broader consideration. The
College is examining the paper and is preparing a media release for release
in the coming days.

Kind regards,

Ramon

Professor Ramon Z Shaban
PRESIDENT

Australasian College for Infection Prevention and Control

GPO Box 3254, Brisbane Qld 4001

On 25 February 2016 at 21:16, Glenys Harrington
wrote:

Dear All,

Find attached the following publication (February 9, 2016).

. Graves et al. Cost-Effectiveness of a National Initiative to
Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated
Staphylococcus aureus Bacteraemia. PLoS ONE 11(2): e0148190.
doi:10.1371/journal.

The analysis was undertaken on data from 6 Australian states:

. In 2/6 states there was a 1% chance it was cost effective

. In 1/6 states there was a 26% chance it was cost effective

. In 1/6 states there was a 80% chance it was cost effective and

. In 2/6 a 100% chance it was cost effective.

Interesting figure showing cost increases and cost savings by state (fig 2).

Also some interesting points in the discussion.

Shame there was “No useable pre-implementation” data available for Victoria
and hence was not able to be analysed.

Given the findings of the analysis it raises the following questions for
governments:

. Shouldn’t the program be scaled back and some of the money be
spent on other initiatives to reduce hospitals associated infections(HAIs)?

. Shouldn’t the program be scaled back to reduce the infection
control workload associated with the program which is currently overwhelming
and taking ICPs away from other core infection control activities?

A press release by the College about the findings of this study and the
views of the college in terms of the allocation of limited resources would
be timely.

regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

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[Thomson, Rachel EA (THS)]

Hi Kelly,

At the Royal Hobart Hospital and within the Southern area of the Tasmanian Health Service we have developed a training program for auditors consistent with our preferred approach, which is ANTT. Thus, we have trained a reasonably large number of auditors across the organisation with a requirement for each service to provide at least 1-2 staff to be trained as auditors. The audits are then undertaken in two ways by the local auditors;

* Assessments for new staff in their area as required following completion of on-line education to assess ‘competence’. We have trained staff in nursing, allied health some medical as well (high-risk services DCCM and NPICU at the present time)

* Limited ‘snap-shot’ ANTT auditing over a month twice-yearly. Whilst the total number of twice-yearly ‘snap-shot’ auditing in the local area is quite small, overall we obtain some hundreds of audits from our health service. We believe that this is useful in measuring improvements overall. We have recently reviewed this auditing framework to ensure that auditing includes nursing and medical and, where relevant, allied health.

Our auditors are sourced primarily from the practice development unit (Nurse Educators) who have been very engaged in our program from the outset, as well as Standard 3 Portfolio Holders. Our main role then becomes one of training and supporting ANTT Assessors and coordinating the reporting and feedback from the program.

Kind regards
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South

Please note that my number has changed from 8th March 2016 to
*: 03 6166 7882/ 6166 8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Kelly,

I wonder about the validity of such audits in terms of the Hawthorn effect.

Wouldn’t it be more appropriated and less time consuming to assess competency by doing just-in-time peer review on employment and bi-annually or annually?

Regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

While HH audits can be time consuming, I find them paling in comparison in the time it takes to audit Aseptic Technique, where “moments” for our health service can go for well over 30 minutes. I’m wondering how other health services manage their Aseptic Technique audits. I can spend a whole day auditing and only get 5-6 audits done.

Kelly

Kelly Barton
Infection Prevention & Control Officer
Monday- Friday
P Reduce, re-use, recycle. Please consider the environment before printing this e-mail.

Thank you Mary-Louise for your response re Graves et al study and the variances.

The concerns of biased data reported for hand hygiene compliance is worth noting and I too agree with your comments here.

Costs associated with the efforts to report HH data as required which detracts from some of the critical day to day requirements of the IC nurse need further review.

Thank you
Michelle

Michelle Bibby
Infection Prevention Australia
Michelle@infectionprevention.com.au
+429071165

Dear Ramon and Glenys

Graves et al study relies on the accuracy of the 2 pivotal variables: SAB and hand hygiene compliance. The accuracy of the latter is serious limited. Our report in the Medical Journal of Australia (Med J Aust 2014; 200 (9):534-537. http://dx.doi.org/10.5694/mja13.11203) concluded the HHA program reports rates that have been biased upwards by very few high performers.

The conclusion from our findings and Graves et al is:

(1) SAB respond to multiple interventions and hand hygiene is only one of these.
(2) hygiene compliance rates have not reached a tipping point to reduce SAB and this tipping point is a long way off because
(3) the hand hygiene compliance rates are inaccurate.

It is important to have a national HH program. But the expense of the current program is too high when the cost of audits provides flawed data that reinforces a misguided belief that our hospitals are performing HH well.

Mary-Louise

Professor Mary-Louise McLaws

Professor of Epidemiology in Healthcare Infection and Infectious Diseases Control

http://research.unsw.edu.au/people/professor-marylouise-mclaws

SPHCM SAMUELS BUILDING

UNSW AUSTRALIA, SYDNEY NSW 2052 AUSTRALIA

CRICOS Provider Code 00098G

________________________________
Colleagues

The study by Graves et al. reports a range of interesting findings, and raises many issues regarding hand hygiene for broader consideration. The College is examining the paper and is preparing a media release for release in the coming days.

Kind regards,
Ramon

Professor Ramon Z Shaban
PRESIDENT

Australasian College for Infection Prevention and Control

GPO Box 3254, Brisbane Qld 4001

On 25 February 2016 at 21:16, Glenys Harrington <infexion@ozemail.com.au> wrote:
Dear All,

Find attached the following publication (February 9, 2016).

* Graves et al. Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia. PLoS ONE 11(2): e0148190. doi:10.1371/journal.

The analysis was undertaken on data from 6 Australian states:

* In 2/6 states there was a 1% chance it was cost effective

* In 1/6 states there was a 26% chance it was cost effective

* In 1/6 states there was a 80% chance it was cost effective and

* In 2/6 a 100% chance it was cost effective.

Interesting figure showing cost increases and cost savings by state (fig 2).

Also some interesting points in the discussion.

Shame there was “No useable pre-implementation” data available for Victoria and hence was not able to be analysed.

Given the findings of the analysis it raises the following questions for governments:

* Shouldn’t the program be scaled back and some of the money be spent on other initiatives to reduce hospitals associated infections(HAIs)?

* Shouldn’t the program be scaled back to reduce the infection control workload associated with the program which is currently overwhelming and taking ICPs away from other core infection control activities?

A press release by the College about the findings of this study and the views of the college in terms of the allocation of limited resources would be timely.

regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

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[Ruth Ryburn]

Good morning,

I have read the discussion around this issue and publication with interest… but limited understanding.
Would someone please be able to explain in simple terms the phrase:

…….changed from $29,700 per life year gained to $25,094 per life year gained….

Thank you,

Ruth Ryburn
Infection Control Coordinator

[DPH_logo]
58 Quirk Street
Dee Why, NSW 2099
T: (02) 8978 5276
F: (02) 9971 7299
M: 0414 801 660

The content of this e-mail is the view of the sender or stated author and does not necessarily reflect the view of Delmar Private Hospital. The content, including attachments, is a confidential communication between of Delmar Private Hospital and the intended recipient. If you are not the intended recipient, any use, interference with, disclosure or copying of this e-mail, including attachments is unauthorised and expressly prohibited. If you have received this e-mail in error please contact the sender immediately and delete the e-mail and any attachments from your system.
P Please consider the environment before printing this email

[Posted on behalf of the original authors – Moderator}

As the University based authors of this paper, we also welcome this discussion. It was a challenging and difficult study but that made it interesting. With almost $1M of funding from the NHMRC and ACSQHC we felt a large responsibility to do the best possible study. We have no prior position or biases about the value of the NHHI.

In response to the specific points raised by Lindsay and Andrew:

o When we halved the costs of running Hand Hygiene Australia (HHA) the main result changed from $29,700 per life year gained to $25,094 per life year gained

o When we additionally reduced the estimated time spent on audits by hand hygiene auditors by 50% the main result changed from $25,094 per life year gained to $18,960 per life year gained.

o S. aureus bloodstream infections were chosen as the outcome measure by the steering committee for the project, and the reasoning was sound. The data are reliable for the states and territories, SAB is very expensive to treat and has large mortality risk. It is likely the best outcome measure to demonstrate the cost-effectiveness of the NHHI.

o We did an analysis of other infection outcomes that showed a statistically significant reduction in 11/23 infection rates, no change for 9/23 and increases for 3/23. Here is the paper http://www.publish.csiro.au/?paperHI14033

o Including quality of life changes had a negligible impact on the results.

o We responded to Lindsay’s letter in JHI here http://www.ncbi.nlm.nih.gov/pubmed/25555834

Estimating the value for money of infection prevention programmes is important, particularly in today’s climate where funding is tight. This situation of scarce resources is likely to be the new ‘normal’ for health services.

Our study, and the interest in it, highlights the need for evaluations to inform policy decisions. As a community we should take every opportunity to build a culture of evidence-based policy. We are obliged to prefer health programmes that deliver good value for money.

Prof Nick Graves, on behalf of the authors

[This post added for continuity – Moderator}

[Posted on behalf of HHA – Moderator]

We welcome discussion regarding this paper, and more broadly of the National Hand Hygiene Initiative. The QUT study was a large and complex project with many issues that warrant discussion and comment. Some of our comments have been previously published (see Grayson ML. J Hosp Infect 89: 137). We’d like to contribute the following points to today’s discussion on this list:

* The annual cost of the NHHI as assessed by this study reflects ‘start-up’ rather than ‘maintenance’ costs. The cost information used in this study is taken from the 2011-2012 financial year (Page et al. J Hosp Infect, 2014;88:141). HHA’s budget, which represented 20% of the NHHI costs, was halved in the subsequent financial year of 2012-13 (on schedule) and has since remained at this lower level.

* Other changes have been made as this program matured. For example, the costing study pre-dates introduction of the ‘HHCApp mobile’ tool. This was developed to reduce total auditing time requirements (by elimination of data entry), while also facilitating immediate feedback and minimising data entry errors. Surveyed hand hygiene auditors that have moved to mobile devices have estimated that this can reduce time spent on audits by up to 50% (we aim to publish). So the cost-effectiveness study no longer reflects current practice.

* The benefits of the NHHI are almost certainly under-estimated. This study only considered health and cost benefits of preventing one type of HAI: S. aureus bloodstream infections. This is because no national measures were available for other infection types or pathogens. But appropriate hand hygiene should have broader benefits, not only for other healthcare-associated infections but also to reduce the transmission of antimicrobial resistance. No assessment of patient suffering was included.

Despite these points, the summary finding of this QUT study was that the NHHI is cost-effective according to Australian standards: “This is the first cost-effectiveness evaluation of a National Hand Hygiene Initiative and shows that overall the programme was cost effective with a cost per life year gained of $29,700.”

The NHHI is unique both in Australia and globally. We believe that its successes have been the result of combining evidence-based interventions and strong collaboration between infection control professionals, jurisdictional authorities, HHA, the Australian Commission on Safety and Quality in Health Care, and other groups. But just as the program has evolved since the 2012 snapshot provided by this study, it should also continue to do so into the future. This discussion is one part of that process.

Andrew Stewardson, National Project Manager, Hand Hygiene Australia
Lindsay Grayson, Director, Hand Hygiene Australia

Thank you Mary-Louise for your response re Graves et al study and the variances.

The concerns of biased data reported for hand hygiene compliance is worth noting and I too agree with your comments here.

Costs associated with the efforts to report HH data as required which detracts from some of the critical day to day requirements of the IC nurse need further review.

Thank you
Michelle

Michelle Bibby
Infection Prevention Australia
Michelle@infectionprevention.com.au
+429071165

Dear Ramon and Glenys

Graves et al study relies on the accuracy of the 2 pivotal variables: SAB and hand hygiene compliance. The accuracy of the latter is serious limited. Our report in the Medical Journal of Australia (Med J Aust 2014; 200 (9):534-537. http://dx.doi.org/10.5694/mja13.11203) concluded the HHA program reports rates that have been biased upwards by very few high performers.

The conclusion from our findings and Graves et al is:

(1) SAB respond to multiple interventions and hand hygiene is only one of these.
(2) hygiene compliance rates have not reached a tipping point to reduce SAB and this tipping point is a long way off because
(3) the hand hygiene compliance rates are inaccurate.

It is important to have a national HH program. But the expense of the current program is too high when the cost of audits provides flawed data that reinforces a misguided belief that our hospitals are performing HH well.

Mary-Louise

Professor Mary-Louise McLaws

Professor of Epidemiology in Healthcare Infection and Infectious Diseases Control

http://research.unsw.edu.au/people/professor-marylouise-mclaws

SPHCM SAMUELS BUILDING

UNSW AUSTRALIA, SYDNEY NSW 2052 AUSTRALIA

CRICOS Provider Code 00098G

________________________________
Colleagues

The study by Graves et al. reports a range of interesting findings, and raises many issues regarding hand hygiene for broader consideration. The College is examining the paper and is preparing a media release for release in the coming days.

Kind regards,
Ramon

Professor Ramon Z Shaban
PRESIDENT

Australasian College for Infection Prevention and Control

GPO Box 3254, Brisbane Qld 4001

On 25 February 2016 at 21:16, Glenys Harrington <infexion@ozemail.com.au> wrote:
Dear All,

Find attached the following publication (February 9, 2016).

* Graves et al. Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia. PLoS ONE 11(2): e0148190. doi:10.1371/journal.

The analysis was undertaken on data from 6 Australian states:

* In 2/6 states there was a 1% chance it was cost effective

* In 1/6 states there was a 26% chance it was cost effective

* In 1/6 states there was a 80% chance it was cost effective and

* In 2/6 a 100% chance it was cost effective.

Interesting figure showing cost increases and cost savings by state (fig 2).

Also some interesting points in the discussion.

Shame there was “No useable pre-implementation” data available for Victoria and hence was not able to be analysed.

Given the findings of the analysis it raises the following questions for governments:

* Shouldn’t the program be scaled back and some of the money be spent on other initiatives to reduce hospitals associated infections(HAIs)?

* Shouldn’t the program be scaled back to reduce the infection control workload associated with the program which is currently overwhelming and taking ICPs away from other core infection control activities?

A press release by the College about the findings of this study and the views of the college in terms of the allocation of limited resources would be timely.

regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

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______________________________________________________________________
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[Trent Yarwood]

Hi Ruth,

Dollars per life-year saved is a pretty standard measure of
cost-effectiveness in health economics.

If you think about what we do in healthcare in terms of economics and
patient outcomes, it can either save money or cost money and can either
save lives/reduce disease or kill people / increase disease.

Things that save money and save lives are no-brainers.
Things that cost money and reduce health are obviously stupid ideas.

The tricky issue is assessing interventions that cost money but improve
health, or (to a lesser extent) save money but are less-good in terms of
health outcomes.

If you have an intervention that prevents 1000 deaths but costs a billion
dollars, you need to consider all of the other things you could do with
that billion dollars and if together, you could prevent more than 1000
deaths by doing them instead, and dollars-per-life-year-saved is one of the
ways of measuring that.

You can read more:

https://en.wikipedia.org/wiki/Cost-effectiveness_analysis
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497852/
http://www.who.int/choice/publications/p_2003_generalised_cea.pdf

(and around $20,000 per life-year saved is a common threshold for
cost-effective care, depending on the circumstances)

Regards,

Trent.

—
Trent Yarwood
trentyarwood@gmail.com

On 24 March 2016 at 09:35, Ruth Ryburn wrote:

> Good morning,
>
>
>
> I have read the discussion around this issue and publication with
> interest but limited understanding.
>
> Would someone please be able to explain in simple terms the phrase:
>
>
>
> *.changed from $29,700 per life year gained to $25,094 per life year
> gained.*
>
>
>
> Thank you,
>
>
>
> *Ruth Ryburn*
>
> *Infection Control Coordinator*
>
>
>
> *[image: DPH_logo]*
>
> *58 Quirk Street*
>
> *Dee Why, NSW 2099*
>
> *T: (02) 8978 5276 *
>
> *F: (02) 9971 7299 *
>
> *M: 0414 801 660 *
>
>
>
> The content of this e-mail is the view of the sender or stated author and
> does not necessarily reflect the view of Delmar Private Hospital. The
> content, including attachments, is a confidential communication between of
> Delmar Private Hospital and the intended recipient. If you are not the
> intended recipient, any use, interference with, disclosure or copying of
> this e-mail, including attachments is unauthorised and expressly
> prohibited. If you have received this e-mail in error please contact the
> sender immediately and delete the e-mail and any attachments from your
> system.
>
> P *Please consider the environment before printing this email*
>
>
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Michael Wishart
> *Sent:* Monday, 21 March 2016 3:04 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: Hand Hygiene Aistralia – Cost effectiveness publication
>
>
>
> [Posted on behalf of the original authors Moderator}
>
>
>
> As the University based authors of this paper, we also welcome this
> discussion. It was a challenging and difficult study but that made it
> interesting. With almost $1M of funding from the NHMRC and ACSQHC we felt a
> large responsibility to do the best possible study. We have no prior
> position or biases about the value of the NHHI.
>
>
>
> In response to the specific points raised by Lindsay and Andrew:
>
>
>
> o When we halved the costs of running Hand Hygiene Australia (HHA) the
> main result changed from $29,700 per life year gained to $25,094 per life
> year gained
>
> o When we additionally reduced the estimated time spent on audits by
> hand hygiene auditors by 50% the main result changed from $25,094 per life
> year gained to $18,960 per life year gained.
>
> o *S. aureus* bloodstream infections were chosen as the outcome measure
> by the steering committee for the project, and the reasoning was sound. The
> data are reliable for the states and territories, SAB is very expensive to
> treat and has large mortality risk. It is likely the best outcome measure
> to demonstrate the cost-effectiveness of the NHHI.
>
> o We did an analysis of other infection outcomes that showed a
> statistically significant reduction in 11/23 infection rates, no change for
> 9/23 and increases for 3/23. Here is the paper
> http://www.publish.csiro.au/?paperHI14033
>
> o Including quality of life changes had a negligible impact on the
> results.
>
> o We responded to Lindsays letter in JHI here
> http://www.ncbi.nlm.nih.gov/pubmed/25555834
>
>
>
> Estimating the value for money of infection prevention programmes is
> important, particularly in todays climate where funding is tight. This
> situation of scarce resources is likely to be the new normal for health
> services.
>
>
>
> Our study, and the interest in it, highlights the need for evaluations to
> inform policy decisions. As a community we should take every opportunity to
> build a culture of evidence-based policy. We are obliged to prefer health
> programmes that deliver good value for money.
>
>
>
> Prof Nick Graves, on behalf of the authors
>
>
>
> [This post added for continuity Moderator}
>
>
>
> [Posted on behalf of HHA – Moderator]
>
> We welcome discussion regarding this paper, and more broadly of the
> National Hand Hygiene Initiative. The QUT study was a large and complex
> project with many issues that warrant discussion and comment. Some of our
> comments have been previously published (see Grayson ML. J Hosp Infect
> 89: 137 ). Wed like to
> contribute the following points to todays discussion on this list:
>
>
>
> – The annual cost of the NHHI as assessed by this study reflects
> start-up rather than maintenance costs. The cost information used in
> this study is taken from the 2011-2012 financial year (Page *et al*. J
> Hosp Infect, 2014;88:141). HHAs budget, which represented 20% of the NHHI
> costs, was halved in the subsequent financial year of 2012-13 (on schedule)
> and has since remained at this lower level.
>
>
>
> – Other changes have been made as this program matured. For example,
> the costing study pre-dates introduction of the HHCApp mobile tool. This
> was developed to reduce total auditing time requirements (by elimination of
> data entry), while also facilitating immediate feedback and minimising data
> entry errors. Surveyed hand hygiene auditors that have moved to mobile
> devices have estimated that this can reduce time spent on audits by up to
> 50% (we aim to publish). So the cost-effectiveness study no longer reflects
> current practice.
>
>
>
> – The benefits of the NHHI are almost certainly under-estimated. This
> study only considered health and cost benefits of preventing one type of
> HAI: *S. aureus* bloodstream infections. This is because no national
> measures were available for other infection types or pathogens. But
> appropriate hand hygiene should have broader benefits, not only for other
> healthcare-associated infections but also to reduce the transmission of
> antimicrobial resistance. No assessment of patient suffering was included.
>
>
>
> Despite these points, the summary finding of this QUT study was that the
> NHHI is cost-effective according to Australian standards: This is the
> first cost-effectiveness evaluation of a National Hand Hygiene Initiative
> and shows that overall the programme was cost effective with a cost per
> life year gained of $29,700.
>
>
>
> The NHHI is unique both in Australia and globally. We believe that its
> successes have been the result of combining evidence-based interventions
> and strong collaboration between infection control professionals,
> jurisdictional authorities, HHA, the Australian Commission on Safety and
> Quality in Health Care, and other groups. But just as the program has
> evolved since the 2012 snapshot provided by this study, it should also
> continue to do so into the future. This discussion is one part of that
> process.
>
>
>
> Andrew Stewardson, National Project Manager, Hand Hygiene Australia
>
> Lindsay Grayson, Director, Hand Hygiene Australia
>
>
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU
> ] *On Behalf Of *Michelle Bibby
> *Sent:* Friday, 26 February 2016 12:26 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: Hand Hygiene Aistralia – Cost effectiveness publication
>
>
>
> Thank you Mary-Louise for your response re Graves et al study and the
> variances.
>
>
>
> The concerns of biased data reported for hand hygiene compliance is worth
> noting and I too agree with your comments here.
>
>
>
> Costs associated with the efforts to report HH data as required which
> detracts from some of the critical day to day requirements of the IC nurse
> need further review.
>
>
>
> Thank you
>
> Michelle
>
>
>
> Michelle Bibby
>
> Infection Prevention Australia
>
> Michelle@infectionprevention.com.au
>
> +429071165
>
>
>
>
>
> *From: *MaryLouise McLaws
> *Reply-To: *ACIPC Infexion Connexion
> *Date: *Thu, 25 Feb 2016 23:24:28 +0000
> *To: *
> *Subject: *Re: FW: Hand Hygiene Aistralia – Cost effectiveness publication
>
>
>
> Dear Ramon and Glenys
>
>
>
> Graves et al study relies on the accuracy of the 2 pivotal variables: SAB
> and hand hygiene compliance. The accuracy of the latter is serious
> limited. Our report in the Medical Journal of Australia (*Med J Aust* 2014;
> 200 (9):534-537. http://dx.doi.org/10.5694/mja13.11203) concluded the HHA
> program reports rates that have been biased upwards by *very few high
> performers*.
>
>
>
> The conclusion from our findings and Graves et al is:
>
>
>
> (1) SAB respond to multiple interventions and hand hygiene is only one of
> these.
>
> (2) hygiene compliance rates have not reached a tipping point to reduce
> SAB and this tipping point is a long way off because
>
> (3) the hand hygiene compliance rates are inaccurate.
>
>
>
>
>
> *It is important to have a national HH program*. But the expense of the
> current program is too high when the cost of audits provides flawed data
> that reinforces a misguided belief that our hospitals are performing HH
> well.
>
>
>
>
>
> Mary-Louise
>
> *Professor Mary-Louise McLaws*
>
> *Professor of Epidemiology in Healthcare Infection and Infectious Diseases
> Control *
>
> http://research.unsw.edu.au/people/professor-marylouise-mclaws
>
> SPHCM SAMUELS BUILDING
>
> UNSW AUSTRALIA, SYDNEY NSW 2052 AUSTRALIA
>
> Telephone: (+612) 9385 2586 FaX: (+612) 93136185
>
> CRICOS Provider Code 00098G
>
>
>
>
> ——————————
>
> *From:* ACIPC Infexion Connexion [AICALIST@AICALIST.ORG.AU] on behalf of
> Professor Ramon Shaban, ACIPC President [president@ACIPC.ORG.AU]
> *Sent:* Friday, 26 February 2016 09:10
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: FW: Hand Hygiene Aistralia – Cost effectiveness publication
>
> Colleagues
>
>
>
> The study by Graves et al. reports a range of interesting findings, and
> raises many issues regarding hand hygiene for broader consideration. The
> College is examining the paper and is preparing a media release for release
> in the coming days.
>
>
>
> Kind regards,
>
> Ramon
>
>
>
>
> *Professor Ramon Z Shaban PRESIDENT*
>
> Australasian College for Infection Prevention and Control
>
> GPO Box 3254, Brisbane Qld 4001
> Tel: +61 7 3735 6463 Mobile: 0478 312 668
>
> Email: president@acipc.org.au
>
> Web: https://www.acipc.org.au
>
>
>
> On 25 February 2016 at 21:16, Glenys Harrington
> wrote:
>
> Dear All,
>
>
>
> Find attached the following publication (February 9, 2016).
>
>
>
> *Graves et al. Cost-Effectiveness of a National Initiative to
> Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated
> Staphylococcus aureus Bacteraemia. PLoS ONE 11(2): e0148190.
> doi:10.1371/journal.*
>
>
>
> The analysis was undertaken on data from 6 Australian states:
>
>
>
> In 2/6 states there was a 1% chance it was cost effective
>
> In 1/6 states there was a 26% chance it was cost effective
>
> In 1/6 states there was a 80% chance it was cost effective and
>
> In 2/6 a 100% chance it was cost effective.
>
>
>
> Interesting figure showing cost increases and cost savings by state (fig
> 2).
>
>
>
> Also some interesting points in the discussion.
>
>
>
> Shame there was No useable pre-implementation data available for
> Victoria and hence was not able to be analysed.
>
>
>
> *Given the findings of the analysis it raises the following questions for
> governments:*
>
>
>
> *Shouldnt the program be scaled back and some of the money be
> spent on other initiatives to reduce hospitals associated infections(HAIs)?*
>
>
>
> * Shouldnt the program be scaled back to reduce the infection
> control workload associated with the program which is currently
> overwhelming and taking ICPs away from other core infection control
> activities?*
>
>
>
> *A press release by the College about the findings of this study and the
> views of the college in terms of the allocation of limited resources would
> be timely.*
>
>
>
>
>
> regards
>
>
>
> Glenys
>
>
>
> *Glenys Harrington*
>
> *Consultant*
>
> *Infection Control Consultancy (ICC)*
>
> *PO Box 5202*
>
> *Middle Park*
>
> *Victoria, 3206*
>
> *Australia*
>
> *M: +61 404 816 434 *
>
> *infexion@ozemail.com.au*
>
> *ABN 47533508426*
>
>
>
>
>
>
>
>
>
>
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
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> ______________________________________________________________________
> For the purposes of protecting the integrity and security of the SVHA
> network and the information held on it, all emails to and from any email
> address on the svha.org.au domain (or any other domain of St Vincents
> Health Australia Limited or any of its related bodies corporate) (an SVHA
> Email Address) will pass through and be scanned by the Symantec.cloud anti
> virus and anti spam filter service. These services may be provided by
> Symantec from locations outside of Australia and, if so, this will involve
> any email you send to or receive from an SVHA Email Address being sent to
> and scanned in those locations.
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> Archive of all messages are available at http://aicalist.org.au/archives
> – registration and login required.
>
> Replies to this message will be directed back to the list. To create a new
> message send an email to aicalist@aicalist.org.au
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>
>
> ______________________________________________________________________
> For the purposes of protecting the integrity and security of the SVHA
> network and the information held on it, all emails to and from any email
> address on the svha.org.au domain (or any other domain of St Vincents
> Health Australia Limited or any of its related bodies corporate) (an SVHA
> Email Address) will pass through and be scanned by the Symantec.cloud anti
> virus and anti spam filter service. These services may be provided by
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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