Use of maximal sterile barriers during central venous catheter insertion: clinical and economic outcomes.
BACKGROUND
We performed a cost-effectiveness analysis to determine the effect of maximal sterile barriers (MSBs) on reducing central venous catheter (CVC)--related infections. Use of MSBs when placing CVCs may reduce the risk of infections but is more cumbersome, time-consuming, and expensive than other techniques.


METHODS
We developed a decision analytic model in which a patient could have a CVC placed with either an MSB or a less stringent technique. We calculated total direct medical costs and the incidences of catheter-related bloodstream infections, catheter colonization, and death.


RESULTS
Use of MSBs lowered costs (from 621 dollars to 369 dollars per catheter insertion) and decreased the incidences of catheter-related bloodstream infections (from 5.3% to 2.8%), catheter colonization with local infection (from 5.5% to 2.9%) and death (from 0.8% to 0.4%). MSBs improved patient safety throughout all sensitivity analyses.


CONCLUSIONS
Use of MSBs during CVC insertion likely lowers medical costs and decreases the incidences of catheter colonization, catheter-related bloodstream infections, and death. Cost savings were found over a wide range of clinical and economic assumptions, suggesting that MSBs should be routinely used when CVCs are inserted.
Hu
Kent K
KK
Northwest Health Services Research and Development Program, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle 98108, USA. kenthu@u.washington.edu <kenthu@u.washington.edu>
Veenstra
David L
DL
Lipsky
Benjamin A
BA
Saint
Sanjay
S
D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003365:Costs and Cost Analysis; D006801:Humans; D007239:Infections / Q000209:etiology*; D013242:Sterilization / Q000191:economics* / Q000379:methods*