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

doi:10.1016/j.ajic.2005.08.004

American Journal of Infection Control

Volume 34, Issue 6, August 2006, Pages 388-393

https://doi.org/10.1016/j.ajic.2005.08.004 Get rights and content

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.

Section snippets

Methods

We conducted a prospectively designed before-and-after cohort study, collecting data 2 years before and 2 years after an intervention that involved using catheters coated with chlorhexidine/silver-sulfadiazene in the 6 adult intensive care units at the University of Michigan Health System, a large tertiary care center. Pediatric units were excluded. During catheter insertion, povidone-iodine was used for site disinfection throughout the study, and hospital guidelines recommended the use of

Results

We found both statistically and clinically significant decreases in CRBSI rates. Using a paired t test, we found that the CRBSI rate prior to the intervention was fairly stable at 8.2 infections per 1000 catheter days. The CRBSI rate after the intervention was 5.4 infections per 1000 catheter days, which represented a 35% relative risk reduction (P = .0003).

Fig 1 shows a graph of monthly rates of CRBSI for all adult intensive care units, with separate regression lines added to show trends for

Discussion

Our before-and-after intervention revealed that antiseptic-coated catheters appeared to enhance patient safety and decrease health care costs under a variety of assumptions in a real-world setting. The 35% relative risk reduction in CRBSI that we found was similar to the 40% reduction found in efficacy studies.¹⁶ Poisson results, adjusting for confounding effects of time and other external changes, show a decrease in CRBSI of 4% per month.

Vancomycin-resistant enterococcal bacteremia is

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: 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.).

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Major ArticleAre antiseptic-coated central venous catheters effective in a real-world setting?

Background

Objective

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Lancet

Zentralbl Bakteriol

J Hosp Infect

Am J Infect Control

National Nosocomial Infections Surveillance (NNIS) System report, Data summary from January 1990-May 1999, issued June 1999

Am J Infect Control

Prevention of intravascular catheter-related infections

Ann Intern Med

Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality

JAMA

Intravascular catheter associated sepsis: a common problem. The Australian Study on Intravascular Catheter Associated Sepsis

Med J Aust

A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies

Medicine (Baltimore)

The clinical and economic consequences of nosocomial central venous catheter-related infection: are antimicrobial catheters useful?

Infect Control Hosp Epidemiol

Evaluation of outcome of intravenous catheter-related infections in critically ill patients

Am J Respir Crit Care Med

Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit

Arch Surg

Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection

JAMA

Catheter-related sepsis: prospective, randomized study of three methods of long-term catheter maintenance

Crit Care Med

A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters

N Engl J Med

Impact of handwashing on mortality in intensive care: examination of the evidence

Infect Control Hosp Epidemiol

Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units

N Engl J Med

Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients

Crit Care Med

Major Article
Are antiseptic-coated central venous catheters effective in a real-world setting?