Monday, Nov 3
Melvin Stephens, Estimating Program Benefits
Borschel, D.M., C.E. Chenoweth, S.R. Kaufman, K.V. Hyde, K.A. VanDerElzen, Trivellore Raghunathan, C.D. Collins, and S. Saint. 2006. "Are antiseptic-coated central venous catheters effective in a real-world setting?" American Journal of Infection Control, 34(6): 388-393.
Background: Catheter-related bloodstream infections are common, costly, and morbid. Randomized controlled trials indicate that antiseptic-coated central venous catheters reduce infection rates.
Objective: To assess the clinical and economic effectiveness of antiseptic-coated catheters for critically ill patients in a real-world setting.
Methods: Central venous catheters coated with chlorhexidine/silver-sulfadiazene were introduced in all patients requiring central venous access in adult intensive care units at the University of Michigan Health System, a large, tertiary care teaching hospital. A pretest-post-test cohort design measured the primary outcome of catheter-related bloodstream infection rate, comparing the 2 years prior to the intervention with the 2 years following the intervention. We also evaluated cost-effectiveness and changes in vancomycin use.
Results: The intervention was associated with a 4% per month relative reduction in the incidence of catheter-related bloodstream infection, after controlling for the effects of time. Overall, a 35% relative risk reduction (P < .0003) in the catheter-related bloodstream infection rate occurred in the posttest phase. The use of antiseptic-coated catheters reduced costs more than $100,000 annually. Vancomycin use was less in units in which antiseptic catheters were used compared with wards in which these catheters were not used.
Conclusion: Antiseptic-coated catheters appear to be clinically effective and economically efficient in a real-world setting.