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Economic Value of Dispensing Home-Based Preoperative Chlorhexidine Bathing Cloths to Prevent Surgical Site Infection

Published online by Cambridge University Press:  02 January 2015

Rachel R. Bailey ,
Dianna R. Stuckey ,
Bryan A. Norman ,
Andrew P. Duggan ,
Kristina M. Bacon ,
Diana L. Connor ,
Ingi Lee ,
Robert R. Muder  and
Bruce Y. Lee
Rachel R. Bailey*
Affiliation:
Public Health Computational and Operations Research Group, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
Dianna R. Stuckey
Affiliation:
Public Health Computational and Operations Research Group, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
Bryan A. Norman
Affiliation:
Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
Andrew P. Duggan
Affiliation:
Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
Kristina M. Bacon
Affiliation:
Public Health Computational and Operations Research Group, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
Diana L. Connor
Affiliation:
Public Health Computational and Operations Research Group, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
Ingi Lee
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Evidence-Based Practice of the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Robert R. Muder
Affiliation:
Division of Infectious Diseases, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Bruce Y. Lee
Affiliation:
Public Health Computational and Operations Research Group, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
*
Public Health Computational and Operations Research (PHICOR), University of Pittsburgh, 3520 Forbes Avenue, First Floor, Pittsburgh, PA 15213 ([email protected])
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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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 5 , May 2011 , pp. 465 - 471
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1. Graves, N, Harbarth, S, Beyersmann, J, Barnett, A, Halton, K, Cooper, B. Estimating the cost of health care-associated infections: mind your p's and q's. Clin Infect Dis 2010;50(7):1017–1021.CrossRefGoogle ScholarPubMed
2. de Lissovoy, G, Fraeman, K, Hutchins, V, Murphy, D, Song, D, Vaughn, BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37(5):387–397.CrossRefGoogle ScholarPubMed
3. Evans, RP. Surgical site infection prevention and control: an emerging paradigm. J Bone Joint Surg Am 2009;91(suppl 6):2–9.Google Scholar
4. Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR; Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20(4):250–278.CrossRefGoogle ScholarPubMed
5. Lee, BY, Tsui, BY, Bailey, RR, et al. Should vascular surgery patients be screened preoperatively for methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 2009;30(12):1158–1165.Google Scholar
6. Lee, BY, Wiringa, AE, Bailey, RR, et al. Screening cardiac surgery patients for MRSA: an economic computer model. Am J Manag Care 2010;16(7):e163–e173.Google ScholarPubMed
7. Webster, J, Osborne, S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev 2007(2):CD004985.Google Scholar
8. Edmiston, CE Jr, Krepel, CJ, Seabrook, GR, Lewis, BD, Brown, KR, Towne, JB. Preoperative shower revisited: can high topical antiseptic levels be achieved on the skin surface before surgical admission? J Am Coll Surg 2008;207(2):233–239.Google Scholar
9. Johnson, AJ, Daley, JA, Zywiel, MG, Delanois, RE, Mont, MA. Preoperative Chlorhexidine preparation and the incidence of surgical site infections after hip arthroplasty. J Arthroplasty 2010;25(6 suppl 1):98–102.CrossRefGoogle ScholarPubMed
10. Zywiel, MG, Daley, JA, Delanois, RE, Naziri, Q, Johnson, AJ, Mont, MA. Advance pre-operative Chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty. Int Orthop doi: 10.1007/S00264-010-1078-5. Published June 20, 2010.Google Scholar
11. Gold, MR, Franks, P, McCoy, KI, Fryback, DG. Toward consistency in cost-utility analyses: using national measures to create condition-specific values. Med Care 1998;36(6):778–792.Google Scholar
12. Kampf, G, Kramer, A. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev 2004;17(4):863–893.Google Scholar
13. Garibaldi, RA. Prevention of intraoperative wound contamination with Chlorhexidine shower and scrub. J Hosp Infect 1988;11(suppl B):5–9.CrossRefGoogle ScholarPubMed
14. Lee, I, Agarwal, RK, Lee, BY, Fishman, NO, Umscheid, CA. Systematic review and cost analysis comparing use of Chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol 2010;31(12):1219–1229.CrossRefGoogle ScholarPubMed
15. Maragakis, LL, Perencevich, EN, Cosgrove, SE. Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther 2008;6(5):751–763.CrossRefGoogle ScholarPubMed
16. Laupacis, A, Feeny, D, Detsky, AS, Tugwell, PX. How attractive does a new technology have to be to warrant adoption and utilization? tentative guidelines for using clinical and economic evaluations. CMAJ 1992;146(4):473–481.Google Scholar
17. Thompson, SG, Nixon, RM. How sensitive are cost-effectiveness analyses to choice of parametric distributions? Med Decis Making 2005;25(4):416–423.CrossRefGoogle ScholarPubMed
18. Farley, JE, Stamper, PD, Ross, T, Cai, M, Speser, S, Carroll, KC. Comparison of the BD GeneOhm methicillin-resistant Staphylococcus aureus (MRSA) PCR assay to culture by use of BBL CHROMagar MRSA for detection of MRSA in nasal surveillance cultures from an at-risk community population. J Clin Microbiol 2008;46(2):743–746.CrossRefGoogle ScholarPubMed
19. Shepard, DS. Cost-effectiveness in health and medicine. By M.R. Gold, J.E Siegel, L.B. Russell, and M.C. Weinstein (eds). New York: Oxford University Press, 1996. J Ment Health Policy Econ 1999;2(2):91–92.Google Scholar
20. Tengs, TO, Wallace, A. One thousand health-related quality-of-life estimates. Med Care 2000;38(6):583–637.CrossRefGoogle ScholarPubMed
21. Pereira, BJ, Shapiro, L, King, AJ, Falagas, ME, Strom, JA, Dinarello, CA. Plasma levels of IL-1 beta, TNF alpha and their specific inhibitors in undialyzed chronic renal failure, CAPD and hemodialysis patients. Kidney Int 1994;45(3):890–896.Google Scholar
22. Zeltzer, E, Bernheim, J, Korzets, Z, et al. Diminished chemokine and cytokine-induced adhesion of CD4+ T cells to extracellular matrix ligands in patients with end-stage renal failure. Isr Med Assoc J 2000;2(4):282–286.Google Scholar
23. Anandh, U, Bastani, B, Ballai, S. Granulocyte-macrophage colony-stimulating factor as an adjuvant to hepatitis B vaccination in maintenance hemodialysis patients. Am J Nephrol 2000;20(1):53–56.CrossRefGoogle ScholarPubMed
24. Fabrizi, F, Ganeshan, SV, Dixit, V, Martin, P. Meta-analysis: the adjuvant role of granulocyte macrophage-colony stimulating factor on immunological response to hepatitis B virus vaccine in end-stage renal disease. Aliment Pharmacol Ther 2006;24(5):789–796.CrossRefGoogle ScholarPubMed
25. Jha, R, Lakhtakia, S, Jaleel, MA, Narayan, G, Hemlatha, K. Granulocyte macrophage colony stimulating factor (GM-CSF) induced sero-protection in end stage renal failure patients to hepatitis B in vaccine non-responders. Ren Fail 2001;23(5):629–636.Google Scholar
26. Singh, NP, Mandai, SK, Thakur, A, et al. Efficacy of GM-CSF as an adjuvant to hepatitis B vaccination in patients with chronic renal failure—results of a prospective, randomized trial. Ren Fail 2003;25(2):255–266.CrossRefGoogle ScholarPubMed
27. Sudhagar, K, Chandrasekar, S, Rao, MS, Ravichandran, R. Effect of granulocyte macrophage colony stimulating factor on hepatitis-B vaccination in haemodialysis patients. J Assoc Physicians India 1999;47(6):602–604.Google ScholarPubMed