A pre-pandemic COVID-19 assessment of the costs of prevention and control interventions for healthcare associated infections in medical and surgical wards in Québec.

BACKGROUND: Healthcare-associated infections (HCAIs) present a major public health problem that significantly affects patients, health care providers and the entire healthcare system. Infection prevention and control programs limit HCAIs and are an indispensable component of patient and healthcare worker safety. The clinical best practices (CBPs) of handwashing, screening, hygiene and sanitation of surfaces and equipment, and basic and additional precautions (e.g., isolation, and donning and removing personal protective equipment) are keystones of infection prevention and control (IPC). There is a lack of rigorous IPC economic evaluations demonstrating the cost-benefit of IPC programs in general, and a lack of assessment of the value of investing in CBPs more specifically. OBJECTIVE: This study aims to assess overall costs associated with each of the four CBPs. METHODS: Across two Quebec hospitals, 48 healthcare workers were observed for two hours each shift, for two consecutive weeks. A modified time-driven activity-based costing framework method was used to capture all human resources (time) and materials (e.g. masks, cloths, disinfectants) required for each clinical best practice. Using a hospital perspective with a time horizon of one year, median costs per CBP per hour, as well as the cost per action, were calculated and reported in 2018 Canadian dollars ($). Sensitivity analyses were performed. RESULTS: A total of 1831 actions were recorded. The median cost of hand hygiene (N = 867) was 20 cents per action. For cleaning and disinfection of surfaces (N = 102), the cost was 21 cents per action, while cleaning of small equipment (N = 85) was 25 cents per action. Additional precautions median cost was $4.1 per action. The donning or removing or personal protective equipment (N = 720) cost was 76 cents per action. Finally, the total median costs for the five categories of clinical best practiced assessed were 27 cents per action. CONCLUSIONS: The costs of clinical best practices were low, from 20 cents to $4.1 per action. This study provides evidence based arguments with which to support the allocation of resources to infection prevention and control practices that directly affect the safety of patients, healthcare workers and the public. Further research of costing clinical best care practices is warranted.

Perspectives of compounding pharmacists on alcohol-based hand sanitizer production and utilization for COVID-19 prevention in Addis Ababa, Ethiopia: A descriptive phenomenology study.

BACKGROUND: Globally, the safety of patients and healthcare providers is at risk due to health care-associated infections (HCAIs). World Health Organization and the Centers for Disease Control and Prevention recommend using alcohol-based hand rub (ABHR) for hand hygiene in healthcare settings to prevent HCAIs. Irrational use of ABHR will have undesirable consequences including wastage of products, exposure of healthcare providers to infections and emergence of microbial resistance to the alcohol in hand sanitizers. This study aimed to explore the perspective and experiences of compounding pharmacists on production and utilization of ABHR solution for coronavirus disease in 2019 (COVID-19) prevention in public hospitals of Addis Ababa, Ethiopia. METHODS: A descriptive qualitative study using in-depth interview of 13 key-informants serving as compounding pharmacists in public hospitals of Addis Ababa, Ethiopia, was conducted. The study participants were identified and selected by purposive sampling. All transcribed interviews were subjected to thematic analysis and transcripts were analyzed manually. FINDINGS: The compounding pharmacists in this study had a mean age of 30.6 (±3.1) years and nine of the thirteen participants were men. Ten participants believed that the compounding practice in their respective sites followed the principles of good compounding practice. More than half of the participants did not believe that ABHR products were used rationally in health facilities. They argued that users did not have enough awareness when and how to use sanitizers. Most of the interviewees reported that compounding personnel had no formal training on ABHR solution production. Study participants suggested incentive mechanisms and reimbursements for experts involved in the compounding of ABHR solutions. CONCLUSION: Three of the compounding pharmacists indicated that ABHR production in their setting lack compliance to good compounding practice due to inadequate compounding room, quality control tests, manpower and equipment. Despite this, most study participants preferred the in-house ABHR products than the commercially available ones. Thus, training, regular monitoring and follow-up of the hospital compounding services can further build staff confidence.