# Disease burden associated with healthcare associated infections

HAIs lead to massive preventable health burden. It is estimated that approximately 20% of all-cause global deaths are due to sepsis: around 11 million potentially avoidable deaths per year (WHO, 2020; Rudd et al, 2020). In SSA, sepsis accounts for 3% of maternal complications and 10% of maternal deaths (Bailey et al, 2017). There are an estimated 2.6 million cases of neonatal sepsis per year leading to 250,000 deaths (Seale et al 2014). In East Africa the neonatal sepsis rate is estimated at 30% of live births (Abate et al, 2020). According to Zaidi et al (2005), more than half of all infants in neonatal units in developing countries acquire an HAI, with a fatality rate ranging between 4%–56%.

Antimicrobial resistance is a major cause for concern, given the waning efficacy of frontline drugs to treat bacterial and viral infections. AMR is the ability of a microorganism (such as bacteria, viruses, fungus, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals, antifungals and antimalarials) from working against it. As a result, standard treatments become ineffective, infections persist and worsen, and may spread to other patients and to healthcare workers. Poor infection control and inadequate sanitary conditions contribute to the spread of AMR.

WASH, HCWM and environmental cleaning services play a key role in stemming the tide of HAIs. Monegro et al (2023) state that universal standard (infection control) measures, such as handwashing with soap and water or using alcohol-based disinfectant before and after each patient visit, are vital in reducing rates of transmission of multi-drug resistant pathogens. Similarly, the WHO practical guide on hospital acquired infections advises three main prevention strategies: patient risk classification, patient-to-patient hygiene measures, and environmental hygiene measures (Ducel et al, 2002). WHO’s World Alliance for Patient Safety advocates that effective hand hygiene is the single most important practice to prevent and control HAIs, which form colonies with multi-drug resistant microbes (Pittet et al, 2006).

# The economics of healthcare associated infections

In implementing measures to control HAIs in general, and AMR in particular, economic considerations are vital to consider in making the best use of limited healthcare resources. Several types of economic study provide different perspectives on the control of HAIs, including cost-of-illness, cost of prevention, cost-benefit analysis, cost-utility analysis, and cost consequence analysis. A rich literature exists on the health and economic consequences of HAIs, although this is mainly in OECD countries (Serra-Burriel et al, 2020).

**Cost-of-illness studies** estimate the medical costs and economic losses due to HAIs. For SSA, Epeh and Fenny (2022) report results for 13 studies estimating additional medical costs and average length of stay (ALOS) due to HAIs, finding significant heterogeneity across studies. In Ethiopia, Gidey et al (2023) compare the cost of treating HAI versus non-HAI patients and find an additional cost of US$58 per HAI (US$6.0 for procedures and investigations, US$4.7 for hospital bed and US$47.2 for drugs) and additional ALOS of 8.3 days. In Ghana, Otieku et al (2023) find that having an HAI increases drug cost by 9% and increased laboratory cost by 85%, and ALOS by 3 days. In Ethiopia, pediatric admissions with HAI have 5 days longer ALOS than without HAI (Sahiledengle et al, 2020). In Tanzania, postoperative hospital stay is 7.6 days longer for patients with HAI (Eriksen et al, 2003). In Rwanda, HAI increase ALOS by 3.6 days (Sutherland et al, 2019).

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