Are antiseptic-coated central venous catheters effective in a real-world setting?
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-posttest 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.


CONCLUSIONS
Antiseptic-coated catheters appear to be clinically effective and economically efficient in a real-world setting.
Borschel
Debaroti M
DM
Department of Internal Medicine, University of Michigan, Ann Arbor, 48109-0376, USA. dborsche@umich.edu
Chenoweth
Carol E
CE
Kaufman
Samuel R
SR
Hyde
Kristi Vander
KV
VanDerElzen
Kristen A
KA
Raghunathan
Trivellore E
TE
Collins
Curtis D
CD
Saint
Sanjay
S
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000891:Anti-Infective Agents, Local / Q000191:economics / Q000494:pharmacology; D000985:Antisepsis / Q000295:instrumentation / Q000379:methods*; D002405:Catheterization, Central Venous / Q000191:economics / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D002710:Chlorhexidine / Q000494:pharmacology; D003428:Cross Infection / Q000191:economics / Q000517:prevention & control*; D006785:Hospitals, University; D006801:Humans; D016012:Poisson Distribution; D012044:Regression Analysis; D018805:Sepsis / Q000191:economics / Q000517:prevention & control*; D012837:Silver Sulfadiazine / Q000494:pharmacology; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D014640:Vancomycin; D002710:Chlorhexidine; D012837:Silver Sulfadiazine