Compared with current hospital cleaning practices, an environmental cleaning bundle is a cost-effective way to prevent healthcare-associated infections (HAI), according to a study published in Clinical Infectious Diseases.

In this stepped-wedge cluster randomized trial, Australian researchers analyzed the cost-effectiveness of an environmental cleaning bundle that was implemented in 11 hospitals in Australia for an average of 35 weeks. All hospitals had established HAI surveillance programs before enrolling in the study.

Cost-effectiveness was evaluated at 62 weeks; bundle effectiveness was modeled using hospital surveillance data collected between May 2015 and July 2017. Cost savings were measured by the value of bed days released and treatment costs avoided. Health benefits gained as a result of fewer cases of Staphylococcus aureus bacteremia (SAB), Clostridium difficile infection (CDI), and vancomycin-resistant enterococci (VRE) infection were measured in quality-adjusted life-years (QALYs).

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Implementation of the environmental cleaning bundle cost approximately AUD$349,000 and generated AUD$147,500 in cost savings. A net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4684 per QALY were gained as a result of infections prevented as a result of the bundle. The intervention was associated with a decrease in SAB and VRE infection rates. The effectiveness of the bundle was an estimated 23.5 SAB infections prevented (95% CI, -15.3 to 62.0) compared with 16.0 VRE infections prevented (95% CI, 0.1-32.1). CDI rates were excluded from subsequent analysis due to insufficient evidence of effectiveness.

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This study is subject to limitations due to the exclusion of low-quality data about the use of detergents, but the effect of this is likely to be small. Costs were not attributed to improving cleaning techniques; the researchers assumed that the number of cleaning staff members within a hospital did not change and that they would be cleaning more effectively as a result of improved product use and cleaning techniques.

Based on data collected from a representative mix of Australian hospitals, the bundled cleaning approach had a >80% chance of being cost-effective. Implementation of bundled cleaning in hospital settings, combined with prospective data collection under a stepped-wedge design, produced high-quality evidence that the cleaning program would be cost-effective in similar hospitals for reducing HAI, particularly SAB and VRE infections.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


White NM, Barnett AG, Hall L, et al. Cost-effectiveness of an environmental cleaning bundle for reducing healthcare associated infections [published online July 30, 2019]. Clin Infect Dis. doi: 10.1093/cid/ciz717