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.

• Authors: Carole Schwebel, Jean-Christophe Lucet, Aurélien Vesin, Xavier Arrault, Silvia Calvino-Gunther, Lila Bouadma, Jean-François Timsit
• Journal: Critical care medicine (Crit Care Med) Vol. 40 Issue 1 Pg. 11-7 (Jan 2012) ISSN: 1530-0293 [Electronic] United States
• PMID: 21926570 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Infective Agents, Local
• Chlorhexidine

Topics

• Anti-Infective Agents, Local (economics, therapeutic use)
• Bandages (adverse effects, economics)
• Catheter-Related Infections (economics, prevention & control, therapy)
• Catheterization, Central Venous (adverse effects, economics, instrumentation, methods)
• Chlorhexidine (economics, therapeutic use)
• Cost-Benefit Analysis
• Health Care Costs
• Humans
• Intensive Care Units (economics)
• Length of Stay (economics)
• Middle Aged
• Surgical Sponges (economics)