Hand hygiene noncompliance and the cost of hospital-acquired methicillin-resistant Staphylococcus aureus infection

Infect Control Hosp Epidemiol. 2010 Apr;31(4):357-64. doi: 10.1086/651096.


Background: Hand hygiene noncompliance is a major cause of nosocomial infection. Nosocomial infection cost data exist, but the effect of hand hygiene noncompliance is unknown.

Objective: To estimate methicillin-resistant Staphylococcus aureus (MRSA)-related cost of an incident of hand hygiene noncompliance by a healthcare worker during patient care.

Design: Two models were created to simulate sequential patient contacts by a hand hygiene-noncompliant healthcare worker. Model 1 involved encounters with patients of unknown MRSA status. Model 2 involved an encounter with an MRSA-colonized patient followed by an encounter with a patient of unknown MRSA status. The probability of new MRSA infection for the second patient was calculated using published data. A simulation of 1 million noncompliant events was performed. Total costs of resulting infections were aggregated and amortized over all events.

Setting: Duke University Medical Center, a 750-bed tertiary medical center in Durham, North Carolina.

Results: Model 1 was associated with 42 MRSA infections (infection rate, 0.0042%). Mean infection cost was $47,092 (95% confidence interval [CI], $26,040-$68,146); mean cost per noncompliant event was $1.98 (95% CI, $0.91-$3.04). Model 2 was associated with 980 MRSA infections (0.098%). Mean infection cost was $53,598 (95% CI, $50,098-$57,097); mean cost per noncompliant event was $52.53 (95% CI, $47.73-$57.32). A 200-bed hospital incurs $1,779,283 in annual MRSA infection-related expenses attributable to hand hygiene noncompliance. A 1.0% increase in hand hygiene compliance resulted in annual savings of $39,650 to a 200-bed hospital.

Conclusions: Hand hygiene noncompliance is associated with significant attributable hospital costs. Minimal improvements in compliance lead to substantial savings.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • Cross Infection / economics*
  • Cross Infection / microbiology
  • Cross Infection / transmission
  • Guideline Adherence / economics*
  • Hand Disinfection / methods
  • Hand Disinfection / standards*
  • Health Personnel / psychology*
  • Hospital Costs*
  • Humans
  • Hygiene
  • Infection Control
  • Infectious Disease Transmission, Professional-to-Patient
  • Methicillin-Resistant Staphylococcus aureus*
  • North Carolina
  • Staphylococcal Infections / economics*
  • Staphylococcal Infections / microbiology
  • Staphylococcal Infections / transmission