Abstract:
Published evidence of the cost-effectiveness of alcohol-based handrub (ABH) for the prevention
of neonatal bloodstream infections (BSI) is limited in sub-Saharan Africa. Therefore,
this study evaluates the cost-effectiveness of a multimodal hand hygiene involving alcoholbased
hand rub (ABH) for the prevention of neonatal BSI in a neonatal intensive care unit
(NICU) setting in Ghana using data from HAI-Ghana study. Design was a before and after
intervention study using economic evaluation model to assess the cost-effectiveness of a
multimodal hand hygiene strategy involving alcohol-based hand rub plus soap and water
compared to existing practice of using only soap and water. We measured effect and cost
by subtracting outcomes without the intervention from outcomes with the intervention. The
primary outcome measure is the number of neonatal BSI episode averted with the intervention
and the consequent cost savings from patient and provider perspectives. The before
and after intervention studies lasted four months each, spanning October 2017 to January
2018 and December 2018 to March 2019, respectively. The analysis shows that the ABH
program was effective in reducing patient cost of neonatal BSI by 41.7% and BSI-attributable
hospital cost by 48.5%. Further, neonatal BSI-attributable deaths and extra length of
hospital stay (LOS) decreased by 73% and 50% respectively. Also, the post-intervention
assessment revealed the ABH program contributed to 16% decline in the incidence of neonatal
BSI at the NICU. The intervention is a simple and adaptable strategy with cost-saving
potential when carefully scaled up across the country. Though the cost of the intervention
may be more relative to using just soap and water for hand hygiene, the outcome is a good
reason for investment into the intervention to reduce the incidence of neonatal BSI and the
associated costs from patient and providers’ perspectives.
