title: Economic evaluation of chlorhexidine-impregnated sponges for preventing catheter-related infections in critically ill adults in the Dressing Study.
abstract: BACKGROUND
  The randomized two-way factorial Dressing Study (1,636 patients, 28,931 catheter days) showed that a chlorhexidine-impregnated sponge decreased the incidence of major catheter-related infections from 1.4‰ to 0.6‰ catheter days, and that scheduled dressing changes every 7 days was not inferior to scheduled changes every 3 days. Here, we assessed the cost benefits of chlorhexidine-impregnated sponge use.
  
  
  METHODS
  Costs directly related to major catheter-related infections and the costs of chlorhexidine-impregnated sponge and contact dermatitis were calculated prospectively using microcosting methods during the original study. The added length of stay in the intensive care unit due to major catheter-related infection was estimated using the disability model and assuming a cost of $2,118/intensive care unit day. The cost of each strategy was estimated based on all costs and on the probability of major catheter-related infection according to the Dressing Study results.
  
  
  METHODS
  None.
  
  
  RESULTS
  Median direct cost of major catheter-related infection was $792. Estimated added length of stay due to major catheter-related infection was 11 days (95% confidence interval [-2 days; 26 days]). Overall cost of major catheter-related infection was $24,090/episode. Each dressing cost $9.08 (146 observations) and each chlorhexidine-impregnated sponge cost $9.73. Assuming a baseline major catheter-related infection incidence of 1.4‰ catheter days, chlorhexidine-impregnated sponge use saved $197 per patient with the 3-day chlorhexidine-impregnated sponge dressing change strategy, and $83 with the 7-day standard dressing change strategy. Chlorhexidine-impregnated sponge use remained cost saving assuming a baseline major catheter-related infection incidence as low as 0.35‰ catheter days, or an overall cost per major catheter-related infections of up to $4,400.
  
  
  CONCLUSIONS
  Chlorhexidine-impregnated sponge for arterial and central venous catheters saves money by preventing major catheter-related infections, even in intensive care units with low baseline major catheter-related infection levels.
  
  
  BACKGROUND
  Clinicaltrials.gov number, NCT00417235.
authors.affiliation: Medical Intensive Care Unit, Albert Michallon University Hospital Grenoble, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lucet
authors.forename: Aurélien
authors.initials: A
authors.lastname: Vesin
authors.forename: Xavier
authors.initials: X
authors.lastname: Arrault
authors.forename: Silvia
authors.initials: S
authors.lastname: Calvino-Gunther
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000891:Anti-Infective Agents, Local / Q000191:economics / Q000627:therapeutic use*; D001458:Bandages / Q000009:adverse effects / Q000191:economics; D055499:Catheter-Related Infections / Q000191:economics / Q000517:prevention & control* / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods; D002710:Chlorhexidine / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D015503:Surgical Sponges / Q000191:economics
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine