title: Use of maximal sterile barriers during central venous catheter insertion: clinical and economic outcomes.
abstract: 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.
authors.affiliation: 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>
authors.forename: Kent K
authors.initials: KK
authors.lastname: Hu
authors.forename: David L
authors.initials: DL
authors.lastname: Veenstra
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Lipsky
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003365:Costs and Cost Analysis; D006801:Humans; D007239:Infections / Q000209:etiology*; D013242:Sterilization / Q000191:economics* / Q000379:methods*