Admission screening testing of patients and staff N95 respirators are cost-effective in reducing COVID-19 hospital-acquired infections 

Fenella McAndrew¹, Romesh G Abeysuriya^1,2, Rachel Sacks-Davis^1,2, Marlya Sammann³, David M Lister³, Daniel West³, Suman S Majumdar^1,2, Nick Scott^1,2 

¹Burnet Institute, Melbourne, Australia, ²Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, ³Victorian Government Department of Health, Australia 

Abstract:  

Background 

COVID-19 outbreaks in acute care settings can have severe consequences for patients, and can be costly due to additional patient bed days and replacement of isolating staff. This study assessed the cost-effectiveness of staff masks and patient admission screening testing to reduce COVID-19 hospital-acquired infections. 

Methods 

An agent-based model was calibrated to data on outbreaks in acute care settings in Victoria, Australia between October 2021 and July 2023. Outbreaks were simulated under different combinations of staff masking and patient admission screening testing. For each scenario, average diagnoses, deaths, quality-adjusted life years from discharged patients, and costs from acute COVID-19 were estimated over a 12-month period. 

Findings 

Compared to no admission screening testing and staff surgical masks, all scenarios were cost saving with health gains. Staff N95s + RAT admission screening of patients was the cheapest, saving A$78.4M [95%UI 44.4M-135.3M] and preventing 1,543 [1,070-2,146] deaths per annum. Both interventions were individually beneficial: staff N95s saved A$54.7M and 854 deaths per annum, while RAT admission screening of patients saved A$57.6M and 1,176 deaths per annum. 

Interpretation 

In acute care settings, staff N95 masks and admission screening testing of patients can reduce hospital-acquired COVID-19 infections and deaths, and are cost saving.