Cost-effectiveness of a hand hygiene program on health care-associated infections in intensive care patients at a tertiary care hospital in Vietnam.

BACKGROUND: The cost-effectiveness of a hand hygiene (HH) program in low- and middle-income countries (LMICs) is largely unknown. We assessed the cost-effectiveness of a HH program in a large tertiary Vietnamese hospital. METHODS: This was a before and after study of a hand hygiene program where HH compliance, incidence of hospital-acquired infections (HAIs), and costs were analyzed.The HH program was implemented in 2 intensive care and 15 critical care units. The program included upgrading HH facilities, providing alcohol-based handrub at point of care, HH campaigns, and continuous HH education. RESULTS: The HH compliance rate increased from 25.7% to 57.5% (P < .001). The incidence of patients with HAI decreased from 31.7% to 20.3% (P < .001) after the intervention. The mean cost for patients with HAI was $1,908, which was 2.5 times higher than the costs for patients without an HAI. The mean attributable cost of an HAI was $1,131. The total cost of the HH program was $12,570, which equates to a per-patient cost of $6.5. The cost-effectiveness was estimated at -$1,074 or $1,074 saved per HAI prevented. The intervention remained cost savings under various scenarios with lower HAI rates. CONCLUSION: The HH program is an effective strategy in reducing the incidence of HAIs in intensive care units and is cost-effective in Vietnam. HH programs need to be encouraged across Vietnam and other LMICs.

Mammalian skull heterochrony reveals modular evolution and a link between cranial development and brain size.

The multiple skeletal components of the skull originate asynchronously and their developmental schedule varies across amniotes. Here we present the embryonic ossification sequence of 134 species, covering all major groups of mammals and their close relatives. This comprehensive data set allows reconstruction of the heterochronic and modular evolution of the skull and the condition of the last common ancestor of mammals. We show that the mode of ossification (dermal or endochondral) unites bones into integrated evolutionary modules of heterochronic changes and imposes evolutionary constraints on cranial heterochrony. However, some skull-roof bones, such as the supraoccipital, exhibit evolutionary degrees of freedom in these constraints. Ossification timing of the neurocranium was considerably accelerated during the origin of mammals. Furthermore, association between developmental timing of the supraoccipital and brain size was identified among amniotes. We argue that cranial heterochrony in mammals has occurred in concert with encephalization but within a conserved modular organization.

Acoustic effects accurately predict an extreme case of biological morphology.

The biosonar system of bats utilizes physical baffle shapes around the sites of ultrasound emission for diffraction-based beam forming. Among these shapes, some extreme cases have evolved that include a long noseleaf protrusion (sella) in a species of horseshoe bat. We have evaluated the acoustic cost function associated with sella length with a computational physics approach and found that the extreme length can be predicted accurately from a fiducial point on this function. This suggests that some extreme cases of biological morphology can be explained from their physical function alone.