Cost-Effectiveness of Multifaceted Built Environment Interventions for Reducing Transmission of Pathogenic Bacteria in Healthcare Facilities

Marietta M. Squire, Takeru Igusa, Sauleh Siddiqui, Gareth K. Sessel, Edward N. Squire

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objectives: The objective of this study is to determine the optimal allocation of budgets for pairs of alterations that reduce pathogenic bacterial transmission. Three alterations of the built environment are examined: handwashing stations (HW), relative humidity control (RH), and negatively pressured treatment rooms (NP). These interventions were evaluated to minimize total cost of healthcare-associated infections (HAIs), including medical and litigation costs. Background: HAIs are largely preventable but are difficult to control because of their multiple mechanisms of transmission. Moreover, the costs of HAIs and resulting mortality are increasing with the latest estimates at US$9.8 billion annually. Method: Using 6 years of longitudinal multidrug-resistant infection data, we simulated the transmission of pathogenic bacteria and the infection control efforts of the three alterations using Chamchod and Ruan’s model. We determined the optimal budget allocations among the alterations by representing them under Karush–Kuhn–Tucker conditions for this nonlinear optimization problem. Results: We examined 24 scenarios using three virulence levels across three facility sizes with varying budget levels. We found that in general, most of the budget is allocated to the NP or RH alterations in each intervention. At lower budgets, however, it was necessary to use the lower cost alterations, HW or RH. Conclusions: Mathematical optimization offers healthcare enterprise executives and engineers a tool to assist with the design of safer healthcare facilities within a fiscally constrained environment. Herein, models were developed for the optimal allocation of funds between HW, RH, and negatively pressured treatment rooms (NP) to best reduce HAIs. Specific strategies vary by facility size and virulence.

Original languageEnglish (US)
Pages (from-to)147-161
Number of pages15
JournalHealth Environments Research and Design Journal
Issue number2
StatePublished - Apr 1 2019


  • CRE
  • MRSA
  • VRE
  • airborne transmission
  • design
  • healthcare-associated infections
  • hospital
  • hospital hygiene
  • infection control
  • patient safety

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Critical Care and Intensive Care Medicine


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