Abstract：
OBJECTIVE: To evaluate whether the costs of a successful tailored multifaceted strategy to improve hand hygiene compliance outweighed the savings by reducing infection costs in Dutch long-term care facilities (LTCFs).
METHODS: A retrospective cost analysis alongside a stepped-wedge cluster-randomized controlled trial.
METHODS: The study included 14 LTCFs (23 wards) in the Netherlands.
METHODS: The cost analysis was based on the costs of the intervention vs the savings from avoided infections and associated treatment costs. Infection-related costs of the \"usual-care\" period were compared with the combined infection-related costs and intervention costs from the \"intervention\" period and the costs in the \"post-intervention period.\" Multilevel analyses, with a linear model with periods as fixed effects, random effects for cluster LTCFs, and fixed effects for each step, were completed.
RESULTS: There are no significant differences in total costs considering the 3 periods. When adjusting for time and clustering, the mean infection-related costs per week per LTCF for all the infections combined were highest during \"usual-care\" before the hand hygiene intervention was performed, namely 680 euros per week. Assuming the effect of the improvement strategy would be present for 12 months, the costs per week in the \"intervention\" and \"post-intervention\" periods were 627 euros (95% CI, 383-871) and 731 euros (95% CI, 508-954), respectively. Assuming the effect of the improvement strategy will last longer than 1 year (ie, 18 and 24 months), the average cost for the \"intervention period\" and the \"post-intervention\" period decreased to 615 euros and 719 euros during the intervention and 609 euros and 715 euros after the intervention, respectively.
CONCLUSIONS: Our multifaceted hand hygiene improvement strategy achieves cost savings. The results of our study are the first of an economic analysis of a hand hygiene improvement strategy in LTCFs. The results need to be confirmed by further economic evaluations.
METHODS: A retrospective cost analysis alongside a stepped-wedge cluster-randomized controlled trial.
METHODS: The study included 14 LTCFs (23 wards) in the Netherlands.
METHODS: The cost analysis was based on the costs of the intervention vs the savings from avoided infections and associated treatment costs. Infection-related costs of the \"usual-care\" period were compared with the combined infection-related costs and intervention costs from the \"intervention\" period and the costs in the \"post-intervention period.\" Multilevel analyses, with a linear model with periods as fixed effects, random effects for cluster LTCFs, and fixed effects for each step, were completed.
RESULTS: There are no significant differences in total costs considering the 3 periods. When adjusting for time and clustering, the mean infection-related costs per week per LTCF for all the infections combined were highest during \"usual-care\" before the hand hygiene intervention was performed, namely 680 euros per week. Assuming the effect of the improvement strategy would be present for 12 months, the costs per week in the \"intervention\" and \"post-intervention\" periods were 627 euros (95% CI, 383-871) and 731 euros (95% CI, 508-954), respectively. Assuming the effect of the improvement strategy will last longer than 1 year (ie, 18 and 24 months), the average cost for the \"intervention period\" and the \"post-intervention\" period decreased to 615 euros and 719 euros during the intervention and 609 euros and 715 euros after the intervention, respectively.
CONCLUSIONS: Our multifaceted hand hygiene improvement strategy achieves cost savings. The results of our study are the first of an economic analysis of a hand hygiene improvement strategy in LTCFs. The results need to be confirmed by further economic evaluations.
摘要：
目的：评估在荷兰长期护理机构（LTCF）中通过降低感染成本，成功制定改善手卫生依从性的多方面策略的成本是否超过了节省的成本。
方法：回顾性成本分析以及阶梯式楔形集群随机对照试验。
方法：该研究包括荷兰的14个LTCF（23个病房）。
方法：成本分析基于干预成本与避免感染和相关治疗成本的节省。将“常规护理”期间的感染相关费用与“干预”期间的感染相关费用和干预费用以及干预后期间的费用进行比较。\"多层次分析，用周期作为固定效应的线性模型，集群LTCF的随机效应，和每个步骤的固定效果，已完成。
结果：考虑到3个时期，总成本没有显着差异。当调整时间和聚类时，在进行手部卫生干预之前的“常规护理”期间，所有合并感染的每周平均感染相关费用最高，即每周680欧元。假设改进策略的效果将持续12个月，“干预”和“干预后”期间的每周费用分别为627欧元（95％CI，383-871）和731欧元（95％CI，508-954），分别。假设改进策略的效果将持续超过1年(即，18和24个月），“干预期”和“干预后”期间的平均成本在干预期间降至615欧元和719欧元，干预后降至609欧元和715欧元，分别。
结论：我们多方面的手卫生改进策略可以节省成本。我们的研究结果是对LTCF中的手部卫生改善策略进行经济分析的第一项。结果需要通过进一步的经济评估来确认。
方法：回顾性成本分析以及阶梯式楔形集群随机对照试验。
方法：该研究包括荷兰的14个LTCF（23个病房）。
方法：成本分析基于干预成本与避免感染和相关治疗成本的节省。将“常规护理”期间的感染相关费用与“干预”期间的感染相关费用和干预费用以及干预后期间的费用进行比较。\"多层次分析，用周期作为固定效应的线性模型，集群LTCF的随机效应，和每个步骤的固定效果，已完成。
结果：考虑到3个时期，总成本没有显着差异。当调整时间和聚类时，在进行手部卫生干预之前的“常规护理”期间，所有合并感染的每周平均感染相关费用最高，即每周680欧元。假设改进策略的效果将持续12个月，“干预”和“干预后”期间的每周费用分别为627欧元（95％CI，383-871）和731欧元（95％CI，508-954），分别。假设改进策略的效果将持续超过1年(即，18和24个月），“干预期”和“干预后”期间的平均成本在干预期间降至615欧元和719欧元，干预后降至609欧元和715欧元，分别。
结论：我们多方面的手卫生改进策略可以节省成本。我们的研究结果是对LTCF中的手部卫生改善策略进行经济分析的第一项。结果需要通过进一步的经济评估来确认。
