OBJECTIVE To compare the cost benefit of different environmental sanitation management strategies in hematopoietic stem cell transplantation （HSCT） wards.

METHODS Data on the environmental layout, cleaning and disinfection measures, environmental hygiene surveillance and hospital-associated infections （HAIs） were retrospectively collected from the HSCT wards of Beijing Children's Hospital （Beijing Ward） and Baoding Hospital （Baoding Ward） between Jul. 2021 and Aug. 2024. The costs of environmental hygiene management were calculated, and the effectiveness of environmental hygiene management was analyzed.

RESULTS Among 1 788 hospitalizations, 150 patients developed 181 HAI episodes. After adjusting for underlying diseases （covariates）, the difference in infection rates between the two wards was statistically significant （12.09% vs. 7.26%, P=0.002）. Of the 6 906 environmental and hand hygiene samples collected, the positivity rates in the Beijing Ward versus the Baoding Ward were 9.65% vs. 0.08% for air （P＜0.001）, 17.80% vs. 0.00% for hand swabs （P＜0.001） and 33.33% vs. 0.00% for surfaces （P=0.013）. The total environmental hygiene management costs were RMB 986 000 and RMB 1 746 300, respectively, yielding cost-effectiveness ratios per positive specimen of RMB 29 880 and RMB 349 260, with an incremental cost-effectiveness ratio （ICER） of −2.72 for environmental management in surveillance. For HAI prevention and control, the cost-effectiveness ratios were RMB 12 200 and RMB 25 300 per HAI case, respectively, with an ICER of −6.36 for environmental management in HAI prevention.

CONCLUSION The execution of environmental hygiene management strategies has not been standardized across the two wards, with considerable gaps in management performance. Consequently, appropriate adjustments and optimization of these strategies, grounded in the ward environment and patient characteristics, are required to achieve economic efficiency in environmental hygiene management.