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

Published:September 29, 2015DOI:


      • We analyze hand hygiene (HH) compliance, incidence of hospital-acquired infection, and cost-effectiveness after applying a HH program in intensive care units in a large tertiary Vietnamese hospital.
      • After hand hygiene (HH) program intervention, the HH compliance rate increased from 25.7% to 57.5% (P < .001), and the incidence of patients with hospital-acquired infection decreased by 36%, from 31.7% to 20.3% (P < .001).
      • The mean cost for patients with hospital-acquired infection (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.
      • Cost-effectiveness was estimated at $1,074 saved per hospital-acquired infection prevented.
      • The hand hygiene (HH) program is an effective strategy in reducing the incidence of hospital-acquired infections and is cost-effective in Vietnam; HH programs need to be encouraged across Vietnam and other low- and middle-income countries.


      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.


      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.


      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.


      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.

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