OBJECTIVES

Clostridium difficile infection (C. difficile; CDI) is the most common hospital-acquired infection in the United States, where it is responsible for over 15,000 deaths and five billion dollars in direct healthcare costs annually. This study evaluates the cost effectiveness of nine infection control interventions at reducing the rates of hospital-onset CDI.

METHODS

Cost-effectiveness analyses were conducted from the hospital perspective, where all costs were converted into 2017 US dollars and effectiveness was measured using quality-adjusted life years (QALYs). The nine tested interventions include daily and terminal cleaning with sporicidal product, patient, visitor, and healthcare worker hand hygiene, reducing patient room transfers, screening for C. difficile colonization at admission, and visitor and healthcare worker contact precautions. Rates of hospital-onset CDI were estimated using our recently published agent-based simulation model of C. difficile transmission in a general 200-bed adult hospital. Cost and utility estimates were derived from the literature.

RESULTS

Six interventions were dominant, compared to baseline standard hospital practices: daily cleaning (saved an average of $407,853 and 26.8 QALYs annually in a 200-bed hospital), screening at admission ($9,143; 13.5 QALYs), patient hand hygiene ($25,699; 4.6 QALYs), healthcare worker hand hygiene ($181,784; 12.9 QALYs), terminal cleaning ($65,007; 9.3 QALYs), and patient transfer ($25,677; 2.3 QALYs). Healthcare worker contact precautions had a mean ICER of $147,666/QALY. Visitor hand hygiene had a mean ICER of $8,541,937/QALY. Visitor contact precautions was dominated.

CONCLUSIONS

Healthcare facilities are a major source of CDI and hospital prevention is critical to decreasing its overall incidence. This is the first study to compare the cost-effectiveness of patient-centered interventions, such as patient hand hygiene and screening at admission, with conventional hospital-centered strategies. Prioritizing highly effective, cost saving interventions such as daily and terminal cleaning is a promising strategy that should be further emphasized in future C. difficile prevention guidelines.