OBJECTIVES : Healthcare-associated infections (HAIs) are among the major causes of morbidity and mortality in healthcare settings. In Italy, the incidence of HAIs is 5-10% and infections caused by antibiotic-resistant microorganisms report a mortality rate of 20-30%. Healthcare environments play an important role in the transmission of HAIs and conventional chemicals-based sanitation shows limitations in controlling surface contamination and related HAIs onset. Recently, a sanitizing procedure based on probiotic detergents (Probiotic Cleaning Hygiene System - PCHS) showed to decrease surface pathogens up to 90% more than conventional disinfectants. This study aimed at evaluating the economic impact of the management of HAIs with PCHS versus chemicals-based sanitation in Italy.

METHODS : A multicentre, prospective, pre-post interventional protocol has been implemented in 5 Italian Hospitals to perform a cost-minimization analysis by comparing the management of HAIs related to pre-intervention (conventional disinfectants) and post-intervention (PCHS) phases, from the hospital perspective. The healthcare resource consumption focused on antibiotic therapy considering that the two sanitizing systems have comparable costs. A propensity-score matching has been performed in order to select, for both periods, patients with overlapping clinical characteristics.

RESULTS : Data were collected from 01.01.2016 to 30.06.2016 for conventional disinfectants and from 01.01.2017 to 30.06.2017 for PCHS, for a total of 11,461 patients. The total number of patients in the two periods after matching resulted 8,320 (4,160 per group). During the pre-phase 191 patients developed at least one HAI and 100 patients developed at least one HAI during the post-phase, showing an incidence rate ratio of 0.47 (CI 95% 0.37-0.60). The total cost for antibiotic therapy resulted 52,004€ and 10,954€ for conventional disinfectants and PCHS, respectively, highlighting a cost reduction of 78.9%.

CONCLUSIONS : Our analysis revealed that PCHS may be a cost-saving strategy compared to conventional disinfectants considering the cost of the management of HAIs related to antibiotic therapy.