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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 660The 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 AustraliaThank 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
MichelleMichelle Bibby
Infection Prevention Australia
Michelle@infectionprevention.com.au
+429071165Dear 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
________________________________
ColleaguesThe 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,
RamonProfessor Ramon Z Shaban
PRESIDENTAustralasian 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
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Hi Rebecca,
Thank you for the excerpt from your MRSA/VRE policy which was interesting.
I did note that you specify using alginate bags for contaminated linen but I was under the impression these were no longer in vogue. Can anyone confirm or otherwise please?
Many thanks,
Ruth Ryburn
Infection Control Coordinator
[cid:image002.jpg@01CD663A.84CFA730]
58 Quirk St
Dee Why, NSW 2099
T: +612 8978 5276
F: +612 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 Rebecca O’Donnell
Sent: Tuesday, 17 July 2012 12:32 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Management of MROs in the Operating SuiteHi Sue,
Here is an excerpt from our MRSA / VRE policy. Hope it helps?
Management of MRSA Positive Patients in the Operating Suite
Ensure the Infection Control Coordinator is notified
Ensure MRSA positive patients be admitted directly to the ward, and then transferred to directly theatre. This will avoid unnecessary travel throughout day surgery unit and other areas of theatre department
For ease of management and cleaning purposes, patients who are known to be colonised or infected with MRSA must be placed last on the theatre list
Ensure patients with MRSA be recovered in the operating room where possible then transferred directly back to the ward
If this is not possible, then the patient will be cared for by designated nurse in recovery area
The operating room and/or recovery area must be thoroughly cleaned with hospital approved cleaning solution for MRSA (see General Cleaning Procedure). This includes the anaesthetic machine, trolley. All horizontal surfaces must be cleaned and walls should be spot cleaned
Ensure non disposable equipment is wiped down with hospital approved cleaning solution for MRSA (see General Cleaning Procedure) before being returned to general use
Ensure all linen is discarded in alginate bags then placed in white linen bags
Ensure all clinical waste e.g. dressings, sputum, blood soaked items be discarded in yellow clinical waste bags/bins
Kind regards,
Rebecca ODonnell | Infection Control Co-ordinator
St Vincent’s Hospital Toowoomba | 22-36 Scott Street TOOWOOMBA 4350
T 07 4690 4042 | F 07 46904400
E rebecca.odonnell@stvincents.org.au | W http://www.stvincents.org.au
Please consider the environment before printing this email.
This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not be duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care (“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference.
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Sue Flockhart
Sent: Monday, 16 July 2012 5:41 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Management of MROs in the Operating SuiteHi All,
We are loking at standardising our approach to the management of patients with known MROs in our operating suite. I am interested to know what other facilites are doing and would you share guidelines/policies etc.
kind Regards
Sue Flockhart
Manager, Infection Prevention & Control Unit Staff Immunisation Clinic Ballarat Health Services Victoria
0437856349
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