Cost Effectiveness Analysis of Hygiene-Based Strategies Aimed Toward Prevention of SSTI and MRSA-Associated SSTI Among U.S. Active Duty Army Trainees

Abstract

iii ACKNOWLEDGMENTSThere are many individuals and organizations that I would like to thank. Without your support this research would never have come to fruition. To the many family and friends that have supported me through the course of this multi-year process, I thank you. To my late father, thanks for believing in me and pushing me to be the very best of myself. The many early struggles were worth it. COPYRIGHT STATEMENTThe author hereby certifies that the use of any copyrighted material in the dissertation manuscript entitled: Cost effectiveness of hygiene strategies aimed toward prevention of SSTI and MRSA-associated SSTI aniong U.S. active duty Army trainees is appropriately acknowledged and, beyond brief excerpts, is with the permission of the copyright owner.[Signature]Stephanie M. Morrison Military health systems datasets were used to retrospectively evaluate lost-time in training and cost burden of overall, S.aureus and MRSA SSTI. ICD-9-CM codes were used to identify skin and soft tissue infections, these codes were then linked with clinical microbiology information to identify S.aureus and MRSA SSTI. Lost time in training was calculated as the sum of time spent away from training due to clinic or hospital visits as well as convalescence and training remediation. Cost of illness was equivalent to the sum of direct medical costs (costs associated with medical care such as office visits, laboratory procedures, and prescriptions) and indirect costs (costs associated with lost work productivity because of illness). A systematic review of the literature was performed to determine the effects of hand and personal hygiene programs aimed toward acute infections like SSTI in terms of risk reduction. Additionally, the cost effectiveness of hygiene strategies aimed toward overall and MRSA SSTI among recruit trainees was evaluated using information obtained from a prospective trial implemented at Fort Benning, Georgia. A decision analysis framework was constructed and cost effectiveness was computed using the costs averted and time averted when using a certain strategy compared to standard practice along the infection pathway. Complicated infections contributed to increased rates, lost time in training, and costs.Increased lost time and costs was observed among those trainees with an overall SSTI who were cultured positive for MRSA, received an I&D procedure and prescribed an antibiotic regimen that covered for MRSA.A systematic review and meta-analysis of the literature revealed that hand and personal hygiene promotions programs had a beneficial effect toward acute communicable infections like gastrointestinal, respiratory, and skin infections. Further analysis revealed that significant heterogeneity existed around the pooled risk ratios, the source of which was not identified. Although a chlorhexidine strategy with a hygiene component was shown to be protective against SSTI within the community, results should be viewed with caution. The studies used to generate this pooled estimate were observational-analytic b...