Surgical hands antisepsis with alcohol-based preparations: cost-effectiveness, compliance of professionals and ecological benefits in the Brazilian healthcare scenario

Abstract

Background: Surgical hands disinfection with alcohol-based solutions effectively removes Gram-positive and Gram-negative organisms (including multi-resistant ones) as well as fungi and viruses. Additionally, the technique requires less time for preparation and produces less skin irritation in the professionals’ hands than washing and brushing with conventional antiseptic products. Evidence allows concluding that alcoholic preparations can replace the alternatives traditionally applied such as chlorhexidine and promote reductions in associated costs, including indirect ones such as water supply and brushes disposal. Objecti[1]ves: To assess the cost-effectiveness of surgical hands disinfection technique with alcohol-based products versus scrubbing with chlorhexidine under the perspective of Brazilian hospitals. Methods: Cost-effectiveness analysis through a decision model by comparing the two techniques for surgical hands disinfection: a) Use of alcoholic solutions (Softalind® Pure, B.Braun Medical AG), b) Scrubbing with chlorhexidine brushes. Outcomes considered were reduction of microbial counting (clinical scenario) and water savings (ecological scenario). Economic outcomes were direct medical costs and indirect costs (water consumption). Results: Incremental cost-effectiveness ratio of the alternative with Softalind® Pure has shown cost-savings (higher effectiveness with lower costs) in both scenarios. Total costs of the technique with Softalind® Pure was 46% lower than the costs of the technique with chlorhexidine brushes. Additionally, the clinical scenario has shown superior effectiveness for the alcoholic solution, due to the higher in vitro microbial counting of 23% than its comparator. In the ecological scenario, the reduction of 18,5 liters of water per procedure with the use of alcoholic solution generates cost savings besides the saving in the water consumption itself. Conclusion: The present evaluation pointed out several advantages for the use of alcoholic solutions for surgical hands disinfection. Among them the significant reduction in microbial counting, improvements in compliance of professionals due to less time for preparation (1 minute for alcohol-based preparations vs. 3 minutes for scrubbing with chlorhexidine) and less irritant effect under the skin, besides great savings in costs and water consumption and brushes disposal. The model has shown the use of alcoholic solutions can bring cost savings even when applied quantities far beyond the ones indicated by the manufacturers and recommended by World Health Organization.