Economic evaluation of chlorhexidine-impregnated sponges for preventing catheter-related infections in critically ill adults in the Dressing Study.

Abstract:

BACKGROUND:The randomized two-way factorial Dressing Study (1,636 patients, 28,931 catheter days) showed that a chlorhexidine-impregnated sponge decreased the incidence of major catheter-related infections from 1.4‰ to 0.6‰ catheter days, and that scheduled dressing changes every 7 days was not inferior to scheduled changes every 3 days. Here, we assessed the cost benefits of chlorhexidine-impregnated sponge use. METHODS:Costs directly related to major catheter-related infections and the costs of chlorhexidine-impregnated sponge and contact dermatitis were calculated prospectively using microcosting methods during the original study. The added length of stay in the intensive care unit due to major catheter-related infection was estimated using the disability model and assuming a cost of $2,118/intensive care unit day. The cost of each strategy was estimated based on all costs and on the probability of major catheter-related infection according to the Dressing Study results. INTERVENTIONS:None. RESULTS:Median direct cost of major catheter-related infection was $792. Estimated added length of stay due to major catheter-related infection was 11 days (95% confidence interval [-2 days; 26 days]). Overall cost of major catheter-related infection was $24,090/episode. Each dressing cost $9.08 (146 observations) and each chlorhexidine-impregnated sponge cost $9.73. Assuming a baseline major catheter-related infection incidence of 1.4‰ catheter days, chlorhexidine-impregnated sponge use saved $197 per patient with the 3-day chlorhexidine-impregnated sponge dressing change strategy, and $83 with the 7-day standard dressing change strategy. Chlorhexidine-impregnated sponge use remained cost saving assuming a baseline major catheter-related infection incidence as low as 0.35‰ catheter days, or an overall cost per major catheter-related infections of up to $4,400. CONCLUSION:Chlorhexidine-impregnated sponge for arterial and central venous catheters saves money by preventing major catheter-related infections, even in intensive care units with low baseline major catheter-related infection levels. TRIAL REGISTRATION:Clinicaltrials.gov number, NCT00417235.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Schwebel C,Lucet JC,Vesin A,Arrault X,Calvino-Gunther S,Bouadma L,Timsit JF

doi

10.1097/CCM.0b013e31822f0604

subject

Has Abstract

pub_date

2012-01-01 00:00:00

pages

11-7

issue

1

eissn

0090-3493

issn

1530-0293

journal_volume

40

pub_type

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