Are antiseptic-coated central venous catheters effective in a real-world setting?
published online 05 December 2005.
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.
Conclusion
Antiseptic-coated catheters appear to be clinically effective and economically efficient in a real-world setting.
Ann Arbor, Michigan
aFrom the Department of Internal Medicine, University of Michigan
bPatient Safety Enhancement Program, Ann Arbor VA Medical Center and the University of Michigan Health System
cDepartment of Infection Control and Epidemiology, University of Michigan
dDepartment of Biostatistics, University of Michigan
eDepartment of Pharmacy Services, University of Michigan Health System
fAnn Arbor VA Health Services Research and Development Center of Excellence, Ann Arbor, MI
Reprint requests: Debaroti M. Borschel, MD, 3116 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0376.
Supported, in part, by a Patient Safety Fellowship award provided by C. R. Bard and the Research Foundation for the Prevention of Complications Associated with Health Care and the VA/UM Patient Safety Enhancement Program and by a Career Development Award from the Health Services Research & Development Program of the Department of Veterans Affairs and a Patient Safety Developmental Center Grant from the Agency for Healthcare Research and Quality (P20-HS11540, to S.S.).
ABSTRACT