Umbrella review of economic evaluations of interventions for the prevention and management of healthcare-associated infections in adult hospital patients

Jack Pollard; Emily Agnew; Nicola Pearce-Smith; Koen B Pouwels; Natasha Salant; Julie V Robotham; REVERSE Consortium

doi:10.1016/j.jhin.2025.01.006

Umbrella review of economic evaluations of interventions for the prevention and management of healthcare-associated infections in adult hospital patients

J Hosp Infect. 2025 Jan 20:S0195-6701(25)00009-X. doi: 10.1016/j.jhin.2025.01.006. Online ahead of print.

Authors

Jack Pollard¹, Emily Agnew², Nicola Pearce-Smith³, Koen B Pouwels⁴, Natasha Salant⁴, Julie V Robotham²; REVERSE Consortium

Affiliations

¹ HCAI/AMR Modelling and Evaluations Team, UK Health Security Agency, London, UK. Electronic address: jack.pollard@ukhsa.gov.uk.
² HCAI/AMR Modelling and Evaluations Team, UK Health Security Agency, London, UK.
³ Knowledge and Library Services, UK Health Security Agency, London, UK.
⁴ Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

PMID: 39842639
DOI: 10.1016/j.jhin.2025.01.006

Abstract

Introduction: Healthcare-associated infections result in worse outcomes for patients and greater financial burden. An estimated 4.8 million HCAIs occurred in hospitals across Europe in 2022-23. Sixty-four percent of antibiotic-resistant infections in Europe are associated with healthcare. It is therefore vital to identify cost-effective interventions. Our objective was to summarise the cost-effectiveness evidence of interventions addressing HCAIs in hospitals.

Methods: An umbrella review was conducted to identify evidence on the cost-effectiveness of antimicrobial stewardship, infection prevention and control, and microbiology and diagnostic stewardship interventions for the prevention and clinical management of HCAIs in adult hospital patients. Medline, Embase and EconLit databases were searched. A qualitative synthesis was undertaken.

Results: Twenty-four systematic reviews met the inclusion criteria, with 101 separate analyses extracted and grouped into 10 intervention and 14 infection/organism categories, across various countries and settings. Most evidence focussed on screening followed by contact precautions, isolation and/or decolonisation, with selective screening most cost-effective. Most IPC bundles were cost-effective, although interventions were heterogeneous. The evidence base was sparse for the remaining intervention categories, with more research required. The limited evidence suggests standalone environmental cleaning, hand hygiene, diagnostics, surveillance, ABS, and decolonisation interventions were mostly cost-effective. The cost-effectiveness of standalone personal protective equipment, and education and training interventions was mixed. Most interventions focussed on methicillin-resistant Staphylococcus aureus and other Gram-positive infections, with more research needed on Gram-negative infections. The comparator was unclear in many extracted analyses.

Conclusions: Cost-effective interventions to address HCAIs in hospitals exist, although more evidence is needed for most interventions.

Keywords: antimicrobial stewardship; antimicrobial-resistance; cost-effectiveness; healthcare-associated infection; infection prevention and control; microbiology and diagnostic stewardship; umbrella review.

Publication types

Review