Nosocomial or healthcare-associated infections (HCAIs) are associated with a financial burden that affects both patients and healthcare institutions worldwide. The clinical best care practices (CBPs) of hand hygiene, hygiene and sanitation, screening, and basic and additional precautions aim to reduce this burden. The COVID-19 pandemic has confirmed these four CBPs are critically important prevention practices that limit the spread of HCAIs. This paper conducted a systematic review of economic evaluations related to these four CBPs using a discounting approach. We searched for articles published between 2000 and 2019. We included economic evaluations of infection prevention and control of Clostridioides difficile-associated diarrhoea, meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenem-resistant Gram-negative bacilli. Results were analysed with cost-minimization, cost-effectiveness, cost-utility, cost-benefit and cost-consequence analyses. Articles were assessed for quality. A total of 11,898 articles were screened and seven were included. Most studies (4/7) were of overall moderate quality. All studies demonstrated cost effectiveness of CBPs. The average yearly net cost savings from the CBPs ranged from $252,847 (2019 Canadian dollars) to $1,691,823, depending on the rate of discount (3% and 8%). The average incremental benefit cost ratio of CBPs varied from 2.48 to 7.66. In order to make efficient use of resources and maximize health benefits, ongoing research in the economic evaluation of

BackgroundNosocomial infections (NIs) are associated with extra treatment costs, medical complications, reduction of quality of life and mortality. This systematic review intends to consolidate the evidence on the economic evaluation of four clinical best practices (CBPs) related to NI prevention and control interventions: hand hygiene, hygiene and sanitation, admission screening and basic and additional precautions. It will measure the return on investment of these CBPs.Methods and analysisElectronic searches will be conducted on MEDLINE, CINAHL, EMBASE, Cochrane, Web of Science and JSTOR. OpenGrey will also be consulted for articles from 2000 to 2018, published in English or French. The population includes studies undertaken in medical or surgical units of hospitals of the Organisation for Economic Co-operation and Development countries. Studies will report the prevention and control of Clostridium difficile-associated diarrhoea, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and carbapenem-resistant Gram-negative bacilli. Interventions evaluating any of the four CBPs will be included. The design of articles will fall within randomised clinical trials, quasi-experimental, case-control, cohort, longitudinal and cross-sectional studies. Outcomes will include incremental cost-effectiveness ratio, incremental cost per quality-adjusted life-year, incremental cost per disability-adjusted life year and the incremental cost-benefit ratio, net costs and net cost savings. Two authors will independently screen studies, extract data and assess risk of bias using the Scottish Intercollegiate Guidelines, the Drummond Economic Evaluation criteria and the Cochrane criteria for Systematic Reviews of Interventions. Consolidated Health Economic Evaluation Reporting Standards will be used for data extraction. All values will be adjusted to Canadian dollars ($C) indexed to 2019 using the discount rates (3%, 5% and 8%) for sensitivity analyses. This review will demonstrate the effectiveness of the CBPs in prevention and control of NIs. Decision-makers will thus have evidence to facilitate sound decision-making according to the financial gains generated.Ethics and disseminationThe results of this systematic review will be published in a peer-reviewed journal and presented at a relevant scientific conference. Ethical approval is not required because the data we will use do not include individual patient data.

Background Nosocomial infections place a heavy burden on patients and healthcare providers and impact health care institutions financially. Reducing nosocomial infections requires an integrated program of prevention and control using key clinical best care practices. No instrument currently exists that measures these practices in terms of personnel time and material costs. Objective To develop and validate an instrument that would measure nosocomial infection control and prevention best care practice costs, including estimates of human and material resources. Methods An evaluation of the literature identified four practices essential for the control of pathogens: hand hygiene, hygiene and sanitation, screening and additional precaution. To reflect time, materials and products used in these practices, our team developed a time and motion guide. Iterations of the guide were assessed in a Delphi technique; content validity was established using the content validity index and reliability was assessed using Kruskall Wallis one-way ANOVA of rank test. Results Two rounds of Delphi review were required; 88% of invited experts completed the assessment. The final version of the guide contains eight dimensions: Identification [83 items]; Personnel [5 items]; Additional Precautions [1 item]; Hand Hygiene [2 items]; Personal Protective Equipment [14 items]; Screening [4 items]; Cleaning and Disinfection of Patient Care Equipment [33 items]; and Hygiene and Sanitation [24 items]. The content validity index obtained for all dimensions was acceptable (> 80%). Experts statistically agreed on six of the eight dimensions. Discussion/Conclusion This study developed and validated a new instrument based on expert opinion, the time and motion guide, for the systematic assessment of costs relating to the human and material resources used in nosocomial infection prevention and control. This guide will prove useful to measure the intensity of the application of prevention and control measures taken before, during and after outbreak periods or during pandemics such as COVID-19.

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Background Healthcare-associated infections (HCAIs) present a major public health problem that significantly affects patients, health care providers and the entire healthcare system. Infection prevention and control programs limit HCAIs and are an indispensable component of patient and healthcare worker safety. The clinical best practices (CBPs) of handwashing, screening, hygiene and sanitation of surfaces and equipment, and basic and additional precautions are keystones of infection prevention and control (IPC). Systematic reviews of IPC economic evaluations report the lack of rigorous empirical evidence demonstrating the cost-benefit of IPC program in general, and point to the lack of assessment of the value of investing in CBPs more specifically. Objective This study aims to assess overall costs associated with each of the four CBPs. Methods Across two Quebec hospitals, 48 healthcare workers were observed for two hours each shift, for two consecutive weeks. A modified time-driven activity-based costing framework method was used to capture all human resources (time) and materials required (e.g. masks, cloths, disinfectants) for each clinical best practice. Using a hospital perspective with a time horizon of one year, median costs per CBP per hour, as well as the cost per action, were calculated and reported in 2018 Canadian dollars. Sensitivity analyses were performed. Results A total of 1831 actions were recorded. The median cost of hand hygiene (N = 867) was 19.6 cents per action. For cleaning and disinfection of surfaces (N = 102), the cost was 21.4 cents per action, while cleaning of small equipment (N = 85) was 25.3 cents per action. Additional precautions median cost was $4.13 per action. The donning or removing or personal protective equipment (N = 720) cost was 75.9 cents per action. Finally, the total median costs for the five categories of clinical best practiced assessed were 27.2 cents per action. Conclusion The costs of clinical best practices were low, from 20 cents to $4.13 per action. This study provides evidence based arguments with which to support the allocation of resources to infection prevention and control practices that directly affect the safety of patients, healthcare workers and the public. Further research of costing clinical best care practices is warranted.