title: Economic value of dispensing home-based preoperative chlorhexidine bathing cloths to prevent surgical site infection.
abstract: OBJECTIVE
  To estimate the economic value of dispensing preoperative home-based chlorhexidine bathing cloth kits to orthopedic patients to prevent surgical site infection (SSI).
  
  
  METHODS
  A stochastic decision-analytic computer simulation model was developed from the hospital's perspective depicting the decision of whether to dispense the kits preoperatively to orthopedic patients. We varied patient age, cloth cost, SSI-attributable excess length of stay, cost per bed-day, patient compliance with the regimen, and cloth antimicrobial efficacy to determine which variables were the most significant drivers of the model's outcomes.
  
  
  RESULTS
  When all other variables remained at baseline and cloth efficacy was at least 50%, patient compliance only had to be half of baseline (baseline mean, 15.3%; range, 8.23%-20.0%) for chlorhexidine cloths to remain the dominant strategy (ie, less costly and providing better health outcomes). When cloth efficacy fell to 10%, 1.5 times the baseline bathing compliance also afforded dominance of the preoperative bath.
  
  
  CONCLUSIONS
  The results of our study favor the routine distribution of bathing kits. Even with low patient compliance and cloth efficacy values, distribution of bathing kits is an economically beneficial strategy for the prevention of SSI.
authors.affiliation: Public Health Computational and Operations Research Group, University of Pittsburgh, Pittsburgh, 3520 Forbes Avenue, First Floor, Pennsylvania 15213, USA. RRB16@pitt.edu
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Bailey
authors.forename: Dianna R
authors.initials: DR
authors.lastname: Stuckey
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Norman
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Duggan
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Bacon
authors.forename: Diana L
authors.initials: DL
authors.lastname: Connor
authors.forename: Ingi
authors.initials: I
authors.lastname: Lee
authors.forename: Robert R
authors.initials: RR
authors.lastname: Muder
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
mesh_terms: D000891:Anti-Infective Agents, Local / Q000191:economics* / Q000627:therapeutic use; D001494:Baths / Q000191:economics* / Q000379:methods; D002710:Chlorhexidine / Q000191:economics* / Q000627:therapeutic use; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003658:Decision Making, Computer-Assisted; D017721:Hospital Costs; D006801:Humans; D018803:Models, Economic; D019637:Orthopedic Procedures; D010349:Patient Compliance; D011300:Preoperative Care / Q000191:economics* / Q000379:methods; D012646:Self Administration; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine