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Restaino S, Tius V, Arcieri M, Biasioli A, Pellecchia G, Driul L, Vizzielli G. "Water or not water: That is the question." Analysis of costs and consumption of the operating theaters in a greener perspective. Int J Gynaecol Obstet 2024; 165:1167-1171. [PMID: 38205879 DOI: 10.1002/ijgo.15325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To compare the amounts of water and plastic used in surgical hand washing with medicated soaps and with alcohol-based products and to compare costs and consumption in a year, based on scheduled surgical activity. METHOD This retrospective study was carried out at Udine's Gynecology Operating Block from October to November 2022. We estimated the average amount of water with a graduated cylinder and the total cost of water usage based on euros/m3 indicated by the supplier; for each antiseptic agent we collected the data relevant to wash time, amount of water and product used per scrub, number of handscrubs made with every 500 mL bottle and cost of a single bottle. We put data into two hypothetical contexts, namely WHO guidelines and manufacturers' recommendations. Data were subjected to statistical analysis. RESULTS The daily amount of water using povidone-iodine, chlorhexidine-gluconate and alcohol-based antiseptic agents was 187.6, 140.7 and 0 L/day (P value = 0.001), respectively; A total of 69 000 L/year of water would be saved if alcohol-based products were routinely used. A single unit of an alcohol-based product allows three times as many handscrubs as any other product (P value = 0.001) with consequent reduction in plastic packaging. CONCLUSION Despite the cost saving being negligible, choosing alcohol-based handrub over medicated soap handrub - on equal antiseptic efficacy grounds - could lead to a significant saving of water and plastic, thus making our operating theaters more environmentally friendly.
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Affiliation(s)
- Stefano Restaino
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Veronica Tius
- Medical Area Department (DAME), University of Udine, Udine, Italy
| | - Martina Arcieri
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, Messina, Italy
| | - Anna Biasioli
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | | | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Medical Area Department (DAME), University of Udine, Udine, Italy
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Medical Area Department (DAME), University of Udine, Udine, Italy
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2
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Chen X, Niu W, Hu G, Chen C. Cost-effectiveness and cost-utility analyses of three different gargles in the treatment of chronic periodontitis. PLoS One 2024; 19:e0302592. [PMID: 38717998 PMCID: PMC11078434 DOI: 10.1371/journal.pone.0302592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the economics of three different gargles in the treatment of chronic periodontitis. METHODS A total of 108 patients with periodontitis received one of the following three gargles: xipayi, compound chlorhexidine, or Kangfuxin gargle. The basic information of the patients, the costs of the gargles, the periodontal indexes before and after treatment, and the scores of the 3-level version of the EuroQol Five Dimensions Questionnaire were collected. The cost-effectiveness and cost-utility of the various gargles were determined. RESULTS The cost-effectiveness ratios (CER) of the three groups after treatment were 1828.75, 1573.34, and 1876.92 RMB, respectively. The utility values before treatment were 0.92, 0.90, and 0.91, respectively, and the utility values after treatment were 0.98, 0.98, and 0.97, respectively. The cost-utility ratios (CURs) were 213.43, 195.61, and 301.53 RMB, respectively. CONCLUSIONS For each increase in effective rate and quality-adjusted life years, the treatment cost of periodontitis patients was lower than the gross domestic product per capita of Jiangsu Province, indicating that the treatment cost is completely worth it. The CER and CUR results were the same, and the compound chlorhexidine group was the lowest, demonstrating that when the same therapeutic effect was achieved, it cost the least.
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Affiliation(s)
- Xin Chen
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
| | - Wenzhi Niu
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
| | - Guangyu Hu
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
| | - Changfeng Chen
- Department of Jiangsu, Xuzhou Stomatological Hospital, Xuzhou, China
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Kline SE, Sanstead EC, Johnson JR, Kulasingam SL. Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization. Infect Control Hosp Epidemiol 2018; 39:1340-1346. [PMID: 30231943 PMCID: PMC8559732 DOI: 10.1017/ice.2018.228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We developed a decision analytic model to evaluate the impact of a preoperative Staphylococcus aureus decolonization bundle on surgical site infections (SSIs), health-care-associated costs (HCACs), and deaths due to SSI. METHODS Our model population comprised US adults undergoing elective surgery. We evaluated 3 self-administered preoperative strategies: (1) the standard of care (SOC) consisting of 2 disinfectant soap showers; (2) the "test-and-treat" strategy consisting of the decolonization bundle including chlorhexidine gluconate (CHG) soap, CHG mouth rinse, and mupirocin nasal ointment for 5 days) if S. aureus was found at any of 4 screened sites (nasal, throat, axillary, perianal area), otherwise the SOC; and (3) the "treat-all" strategy consisting of the decolonization bundle for all patients, without S. aureus screening. Model parameters were derived primarily from a randomized controlled trial that measured the efficacy of the decolonization bundle for eradicating S. aureus. RESULTS Under base-case assumptions, the treat-all strategy yielded the fewest SSIs and the lowest HCACs, followed by the test-and-treat strategy. In contrast, the SOC yielded the most SSIs and the highest HCACs. Consequently, relative to the SOC, the average savings per operation was $217 for the treat-all strategy and $123 for the test-and-treat strategy, and the average savings per per SSI prevented was $21,929 for the treat-all strategy and $15,166 for the test-and-treat strategy. All strategies were sensitive to the probability of acquiring an SSI and the increased risk if SSI if the patient was colonized with SA. CONCLUSION We predict that the treat-all strategy would be the most effective and cost-saving strategy for preventing SSIs. However, because this strategy might select more extensively for mupirocin-resistant S. aureus and cause more medication adverse effects than the test-and-treat approach or the SOC, additional studies are needed to define its comparative benefits and harms.
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Affiliation(s)
- Susan E Kline
- 1Division of Infectious Diseases,Department of Medicine, University of Minnesota Medical School,Minneapolis,Minnesota
| | - Erinn C Sanstead
- 2Division of Epidemiology, University of Minnesota School of Public Health,Minneapolis,Minnesota
| | - James R Johnson
- 1Division of Infectious Diseases,Department of Medicine, University of Minnesota Medical School,Minneapolis,Minnesota
| | - Shalini L Kulasingam
- 2Division of Epidemiology, University of Minnesota School of Public Health,Minneapolis,Minnesota
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Lorente L, Lecuona M, Jiménez A, Cabrera J, Santacreu R, Lorenzo L, Raja L, Mora ML. Chlorhexidine-silver sulfadiazine-impregnated venous catheters are efficient even at subclavian sites without tracheostomy. Am J Infect Control 2016; 44:1526-1529. [PMID: 27378009 DOI: 10.1016/j.ajic.2016.04.236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters have been found to decrease the risk of catheter-related bloodstream infection (CRBSI) and central venous catheter (CVC)-related costs. However, there are no published data about cost-effectiveness of the use of CHSS-impregnated catheters in subclavian venous access without the presence of tracheostomy (thus, with a very low risk of CRBSI). That was the objective of this study. METHODS This was a retrospective study of patients admitted to a mixed intensive care unit who underwent placement of subclavian venous catheters without the presence of tracheostomy. RESULTS Patients with standard catheters (n = 747) showed a higher CRBSI incidence density (0.95 vs 0/1,000 catheter-days; P = .02) and higher CVC-related cost per day ($3.78 ± $7.43 vs $3.31 ± $2.72; P < .001) than patients with a CHSS-impregnated catheter (n = 879). Exact logistic regression analysis showed that catheter duration (P = .02) and the type of catheter used (P = .01) were associated with the risk of CRBSI. Kaplan-Meier method showed that CHSS-impregnated catheters were associated with more prolonged CRBSI-free time than standard catheters (log-rank = 9.76; P = .002). Poisson regression analysis showed that CHSS-impregnated catheters were associated with a lower central venous catheter-related cost per day than standard catheters (odds ratio, 0.87; 95% confidence interval, 0.001-0.903; P < .001). CONCLUSIONS The use of CHSS-impregnated catheters is an effective and efficient measure for the prevention of CRBSI even at subclavian venous access sites without the presence of tracheostomy.
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Affiliation(s)
- Leonardo Lorente
- Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
| | - María Lecuona
- Department of Microbiology and Infection Control, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Alejandro Jiménez
- Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Judith Cabrera
- Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Ruth Santacreu
- Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Lisset Lorenzo
- Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Lorena Raja
- Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - María L Mora
- Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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Maunoury F, Motrunich A, Palka-Santini M, Bernatchez SF, Ruckly S, Timsit JF. Cost-Effectiveness Analysis of a Transparent Antimicrobial Dressing for Managing Central Venous and Arterial Catheters in Intensive Care Units. PLoS One 2015; 10:e0130439. [PMID: 26086783 PMCID: PMC4472776 DOI: 10.1371/journal.pone.0130439] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 05/20/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine gluconate-containing securement dressing compared to non-antimicrobial transparent dressings for the protection of central vascular lines in intensive care unit patients. DESIGN This study uses a novel health economic model to estimate the cost-effectiveness of using the chlorhexidine gluconate dressing versus transparent dressings in a French intensive care unit scenario. The 30-day time non-homogeneous markovian model comprises eight health states. The probabilities of events derive from a multicentre (12 French intensive care units) randomized controlled trial. 1,000 Monte Carlo simulations of 1,000 patients per dressing strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The outcome is the number of catheter-related bloodstream infections avoided. Costs of intensive care unit stay are based on a recent French multicentre study and the cost-effectiveness criterion is the cost per catheter-related bloodstream infections avoided. The incremental net monetary benefit per patient is also estimated. PATIENTS 1000 patients per group simulated based on the source randomized controlled trial involving 1,879 adults expected to require intravascular catheterization for 48 hours. INTERVENTION Chlorhexidine Gluconate-containing securement dressing compared to non-antimicrobial transparent dressings. RESULTS The chlorhexidine gluconate dressing prevents 11.8 infections /1,000 patients (95% confidence interval: [3.85; 19.64]) with a number needed to treat of 85 patients. The mean cost difference per patient of €141 is not statistically significant (95% confidence interval: [€-975; €1,258]). The incremental cost-effectiveness ratio is of €12,046 per catheter-related bloodstream infection prevented, and the incremental net monetary benefit per patient is of €344.88. CONCLUSIONS According to the base case scenario, the chlorhexidine gluconate dressing is more cost-effective than the reference dressing. TRIAL REGISTRATION This model is based on the data from the RCT registered with www.clinicaltrials.gov (NCT01189682).
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Affiliation(s)
| | | | | | | | | | - Jean-François Timsit
- Grenoble University Hospital, Grenoble, France
- IAME UMR1137-Team 5 Decision Sciences in Infectious Disease Prevention, Control and Care, Paris Diderot University-Inserm, Sorbonne Paris Cité, Paris, France
- Paris Diderot University—Bichat University hospital—Medical and Infectious Diseases Intensive care unit, Paris, France
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Crawford AG, Fuhr JP, Rao B. Cost–Benefit Analysis of Chlorhexidine Gluconate Dressing in the Prevention of Catheter-Related Bloodstream Infections. Infect Control Hosp Epidemiol 2015; 25:668-74. [PMID: 15357159 DOI: 10.1086/502459] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjectives:To compare the costs with the benefits of using chlorhexidine gluconate dressings on central venous catheters and to determine the effectiveness of these dressings in reducing local infections and catheter-related bloodstream infections (CRBSIs), costs, and mortality.Design:Cost–benefit analysis using randomized, controlled trial data on chlorhexidine dressing prevention of local infection and CRBSI, data on cost of chlorhexidine dressing versus standard treatment, data on averted cost of treating local infection and CRBSI, and data on mortality attributable to CRBSI. Decision analysis evaluated averted CRBSI treatment cost per patient resulting from chlorhexidine dressing use. Sensitivity analyses demonstrated net benefit of chlorhexidine dressing, varying baseline rate of CRBSI, incremental cost of treating CRBSI, and number of catheters, and evaluated mortality preventable through chlorhexidine dressing use, varying baseline rate of CRBSI, number of catheters, and mortality attributable to CRBSI.Patients and Setting:Patients of all Philadelphia area hospitals and one Philadelphia academic medical center.Results:Estimated potential annual U.S. net benefits from chlorhexidine dressing use ranged from $275 million to approximately $1.97 billion. Cost–benefit findings persisted in sensitivity analyses varying baseline rate of CRBSI, incremental cost of treating CRBSI, and overall number of catheters used. Preventable mortality analyses showed potential decreases of between 329 and 3,906 U.S. deaths annually as a result of nationwide use of chlorhexidine dressing.Conclusions:Chlorhexidine dressings would reduce costs, local infections and CRBSIs, and deaths. Use of chlorhexidine dressings should be considered to prevent infections among patients with catheters.
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Affiliation(s)
- Albert G Crawford
- Department of Health Policy, Jefferson Medical College, Suite 115, 1015 Walnut Street, Philadelphia, PA 19107, USA
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7
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Magalini S, Pepe G, Panunzi S, De Gaetano A, Abatini C, Di Giorgio A, Foco M, Gui D. Observational study on preoperative surgical field disinfection: povidone-iodine and chlorhexidine-alcohol. Eur Rev Med Pharmacol Sci 2013; 17:3367-3375. [PMID: 24379069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Surgical site infection (SSI) rate is reported to range around 16%. Preoperative skin disinfection is keystone for SSI reduction. Chlorhexidine-alcohol has been reported to be more effective than Povidone-iodine (PVI). However, in many countries established habits and the inferior costs of PVI restrain the employment of chlorhexidine disinfection kits (ChloraPrep®) for the preparation of the surgical field. MATERIALS AND METHODS The costs of surgical field preparation in clean-contaminated surgery utilizing PVI (Betadine) and chlorhexidine alcohol and the evaluation of surgeon compliance and satisfaction, were studied by a observational study on 50 surgical operations in which surgical field was prepared with PVI checking established guidelines, and on 50 surgical operations in which chlorhexidine-alcohol (ChloraPrep) was employed. The use of auxiliary material was tabulated as well as the timing of the phases of disinfection and the surgeon's opinions. RESULTS The use of auxiliary material (gloves, gauzes, paper towels, surgical instruments, small swabs for umbilical cleaning) is associated with the type of disinfectant, with major use of auxiliary materials recorded in PVI disinfection. PVI disinfection does not follow stringent guidelines, in particular waiting for the disinfectant to dry. PVI guidelines are more demanding than those relative to ChloraPrep. The time necessary for the preparation of the field is significantly longer for PVI. Auxiliary material and guideline compliance must be taken into account when calculating costs; the former are direct costs (even though marginal) and the latter can determine major infective risk. CONCLUSIONS Chlorhexidine in kits is easier and faster to use than PVI, requires less auxiliary material and has been shown previously to reduce SSI in clean contaminated surgery.
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Affiliation(s)
- S Magalini
- Acute Care and Trauma Surgery, Department of Surgery, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
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Wykoff CC, Flynn HW, Rosenfeld PJ. Prophylaxis for endophthalmitis following intravitreal injection: antisepsis and antibiotics. Am J Ophthalmol 2011; 152:717-9.e2. [PMID: 22017840 DOI: 10.1016/j.ajo.2011.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 07/01/2011] [Accepted: 07/12/2011] [Indexed: 11/19/2022]
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Ye X, Rupnow M, Bastide P, Lafuma A, Ovington L, Jarvis WR. Economic impact of use of chlorhexidine-impregnated sponge dressing for prevention of central line-associated infections in the United States. Am J Infect Control 2011; 39:647-654. [PMID: 21641681 DOI: 10.1016/j.ajic.2010.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 11/15/2010] [Accepted: 11/16/2010] [Indexed: 12/30/2022]
Abstract
BACKGROUND The economic impact of adding chlorhexidine gluconate (CHG)-impregnated sponge dressing to standard care (ie, chg-impregnated sponge dressing + skin preparation and transparent film dressing vs skin preparation and transparent film dressing) for the prevention of central-line infections was evaluated. METHODS Clinical and economic data were obtained from peer-reviewed published studies to populate the decision model. The efficacy of reducing catheter-related bloodstream infection (CR-BSI) incidence with CHG-impregnated sponge dressing came from 2 recent randomized controlled trials. One-way and two-way sensitivity analyses were performed on key clinical and economic parameters. RESULTS Based on model calculations, a hypothetical 400-bed hospital inserting 3,078 central venous catheters (CVCs) per year is expected to avoid an average of 35 CR-BSIs, 145 local infections, and 281 intensive care unit days annually with the systematic use of CHG-impregnated sponge dressing. Potential hospital net cost savings (mainly because of reduced CR-BSIs with use of the dressing) would be $895,000 annually. Results were robust across a range of values in sensitivity analyses. CONCLUSION CHG-impregnated sponge dressing is a cost-effective CR-BSI prevention treatment option for patients requiring CVCs. The importance of these results should be considered in the context of federal government and insurance company policies that no longer permit enhanced reimbursement for CR-BSI.
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Affiliation(s)
- Xin Ye
- Ethicon, Inc, Somerville, NJ.
| | | | | | - Antoine Lafuma
- Cemka Eval Outcomes Research and Epidemiology, Bourg la Reine, France
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Cox SG, Cullingworth L, Rode H. Treatment of paediatric burns with a nanocrystalline silver dressing compared with standard wound care in a burns unit: a cost analysis. S Afr Med J 2011; 101:728-731. [PMID: 22272852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 05/16/2011] [Indexed: 05/31/2023] Open
Abstract
Burns are a leading cause of non-natural death in South African infants and children. Conventional care of partial-thickness burns often requires painful, time consuming and costly twice-daily dressing changes to clean the wound and apply antimicrobial topical agents. A new topical nanocrystalline silver-coated NS dressing (Acticoat; Smith & Nephew) has been developed and is the first-line treatment of choice in many burn centres. However, because of its cost the Department of Health has been reluctant to introduce it as a standard of care. We retrospectively studied 4 randomly selected paediatric burn patients, calculating the cost associated with the use of NS dressings and comparing this with the projected costs of three previously standard burn wound treatment regimens. NS dressings were changed every 3 days based on their sustained and slow release of silver ions over 72 hours. Using NS clearly saved costs compared with the three other regimens. The demonstrated cost savings resulted primarily from the decreased number of dressings, and the presumed shorter hospital stay.
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Webster J, Osborne S. Home-based preoperative chlorhexidine bathing cloths to prevent surgical site infection. Infect Control Hosp Epidemiol 2011; 32:1047; author reply 1047-8. [PMID: 21931260 DOI: 10.1086/662020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Tapia-Jurado J, Reyes-Arellano W, García-García JJ, Jiménez-Corona JL, Peña-Jiménez CM, León-Mancilla B. Comparative study of the cost/effectiveness of surgical wash with various antiseptics. CIR CIR 2011; 79:447-452. [PMID: 22385765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND "Surgical scrub" of the hands and arms is a fundamental procedure for reducing infection risk. We undertook this study in order to compare different antiseptics and their microbicidal effects, costs and times of the procedures. METHODS Thirty students followed the surgical scrub procedure using benzalkonium chloride. Seven days later the students used povidone-iodine and, 7 days after that, they used chlorhexidine/alcohol. After the surgical scrub, cultures were obtained from the palms of their hands and from their nail beds. The students wore sterile gloves, which were removed 30 min later to obtain new cultures from the same sites. The cost of the products was calculated in Mexican pesos and the time of each procedure was measured in minutes. RESULTS There was a statistically significant difference in the number of colony-forming units (CFUs). The number of CFUs was lower in the groups of students who used chlorhexidine/alcohol and povidone-iodine as compared to the benzalkonium chloride group. There was no difference between chlorhexidine/alcohol and povidone-iodine. Costs were higher for povidone-iodine and benzalkonium chloride compared to chlorhexidine/alcohol. Procedure times were similar with povidone-iodine and benzalkonium chloride but the time was reduced approximately five times when using chlorhexidine/alcohol. CONCLUSIONS It is a proven fact that the lack of surgical scrub favors wound infections, longer hospital stays and increased costs. Therefore, further studies are needed to determine the best antiseptic according to cost/benefit. Chlorhexidine/alcohol proved to be the superior antiseptic in terms of cost/benefit compared to povidone-iodine and benzalkonium chloride.
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Affiliation(s)
- Jesús Tapia-Jurado
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México, México, D. F., Mexico.
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Ramos N, Skeete F, Haas JP, Hutzler L, Slover J, Phillips M, Bosco J. Surgical site infection prevention initiative - patient attitude and compliance. Bull NYU Hosp Jt Dis 2011; 69:312-315. [PMID: 22196388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Although the effect of Staphylococcus aureus (SA) decolonization on surgical site infection (SSI) rates has been studied, patient tolerance and acceptance of these regimens has not been assessed. Surgical patients at our hospital's Pre-Admission Testing Clinic (PAT) receive SA reduction protocols instructing the preoperative use of chlorhexidine gluconate (CHG) soap and intranasal mupirocin ointment (MO). Certain insurers do not cover MO costs resulting in out of pocket (OOP) expenses for some patients. OBJECTIVE This study assessed patient attitudes and compliance with our hospital's SA decolonization regimen. METHODS One-hundred-forty-six patients received surveys. Descriptive statistics were used for analysis. RESULTS Of respondents fitting inclusion criteria, 81% followed the MO protocol (MO users) while 89% followed the CHG protocol (CHG users). Fifty-four percent of MO users reported OOP expenses and 13% reported a hard or very hard financial burden. Ninety-three percent of CHG users reported the protocol was easy or very easy to follow. CONCLUSION Eighty-one percent of patients receiving the SA protocol were fully compliant despite cost or difficulty obtaining MO. Given these barriers and some difficulty with CHG application, we hypothesize compliance may be improved if MO is provided to patients without OOP expenses and if the CHG application method is simplified.
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MESH Headings
- Administration, Intranasal
- Adult
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents/administration & dosage
- Anti-Bacterial Agents/economics
- Anti-Infective Agents, Local/economics
- Anti-Infective Agents, Local/therapeutic use
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/economics
- Chlorhexidine/analogs & derivatives
- Chlorhexidine/economics
- Chlorhexidine/therapeutic use
- Female
- Hand Disinfection
- Health Care Costs
- Health Expenditures
- Health Knowledge, Attitudes, Practice
- Humans
- Infection Control/economics
- Infection Control/methods
- Insurance, Health, Reimbursement
- Male
- Middle Aged
- Mupirocin/administration & dosage
- Mupirocin/economics
- New York City
- Nose/microbiology
- Patient Compliance
- Program Evaluation
- Soaps
- Spine/surgery
- Staphylococcal Infections/microbiology
- Staphylococcal Infections/prevention & control
- Staphylococcus aureus/drug effects
- Staphylococcus aureus/isolation & purification
- Surgical Wound Infection/microbiology
- Surgical Wound Infection/prevention & control
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Nicholas Ramos
- Department of Orthopaedic Surgery, NYU Langone Hospital for Joint Diseases, New York, New York, USA.
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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; 31:1219-29. [PMID: 20969449 PMCID: PMC3833867 DOI: 10.1086/657134] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare use of chlorhexidine with use of iodine for preoperative skin antisepsis with respect to effectiveness in preventing surgical site infections (SSIs) and cost. METHODS We searched the Agency for Healthcare Research and Quality website, the Cochrane Library, Medline, and EMBASE up to January 2010 for eligible studies. Included studies were systematic reviews, meta-analyses, or randomized controlled trials (RCTs) comparing preoperative skin antisepsis with chlorhexidine and with iodine and assessing for the outcomes of SSI or positive skin culture result after application. One reviewer extracted data and assessed individual study quality, quality of evidence for each outcome, and publication bias. Meta-analyses were performed using a fixed-effects model. Using results from the meta-analysis and cost data from the Hospital of the University of Pennsylvania, we developed a decision analytic cost-benefit model to compare the economic value, from the hospital perspective, of antisepsis with iodine versus antisepsis with 2 preparations of chlorhexidine (ie, 4% chlorhexidine bottle and single-use applicators of a 2% chlorhexidine gluconate [CHG] and 70% isopropyl alcohol [IPA] solution), and also performed sensitivity analyses. RESULTS Nine RCTs with a total of 3,614 patients were included in the meta-analysis. Meta-analysis revealed that chlorhexidine antisepsis was associated with significantly fewer SSIs (adjusted risk ratio, 0.64 [95% confidence interval, [0.51-0.80]) and positive skin culture results (adjusted risk ratio, 0.44 [95% confidence interval, 0.35-0.56]) than was iodine antisepsis. In the cost-benefit model baseline scenario, switching from iodine to chlorhexidine resulted in a net cost savings of $16-$26 per surgical case and $349,904-$568,594 per year for the Hospital of the University of Pennsylvania. Sensitivity analyses showed that net cost savings persisted under most circumstances. CONCLUSIONS Preoperative skin antisepsis with chlorhexidine is more effective than preoperative skin antisepsis with iodine for preventing SSI and results in cost savings.
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Affiliation(s)
- Ingi Lee
- Divisions of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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Vergara-Fernández O, Morales-Olivera JM, Ponce-de-León-Rosales S, Vega-Batista R, Mejía-Ovalle R, Huertas-Jiménez M, Ponce-de-León A, Navarrete M, Ponce-de-León S, Macías A, Takahashi-Monroy T. [Surgical team satisfaction levels between two preoperative hand-washing methods]. Rev Invest Clin 2010; 62:532-537. [PMID: 21416914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Recently, there have been new antiseptics for surgical scrub that do not require brushing. One of them contains 1% chlorhexidine gluconate and 61% ethyl alcohol; within its benefits, it may offer a low potential for skin sensitization, as well as cost savings and less use of water. OBJECTIVES To evaluate satisfaction levels, washing time, safety, cost and amount of water between the traditional surgical scrub technique (group A) and brush-free surgical scrub procedure (group B). MATERIAL AND METHODS One hundred clean and clean-contaminated surgeries with four hundred members of surgical teams were included. Satisfaction levels, hand-washing time, skin disorders and problems associated with placement of gloves were evaluated. Hands cultures were taken in 20% of the population and the amount of water used by patients in group A was measured. Total costs and wound infections were analyzed. RESULTS Satisfaction scale in group A was 9.1 +/- 1.39 and 9.5 +/- 1.54 in group B (p = 0.004). The mean hand-washing time was 3.9 +/- 1.07 min in group A and 2.0 +/- 0.47 min in group B (p = 0.00001). Thirteen patients had dry skin in group A and four in group B (6.5% vs. 2%; p = 0.02). There were ten positives cultures in group A and five in group B (25% vs. 12.5%, p = 0.152). Wound infection rate was 3%. On average, five-hundred eighty liters of water were used by the former group, and the estimated hand-washing cost was lower in the second group. CONCLUSIONS The handwashing technique with CGEA is as effective as traditional surgical scrub technique, and it is associated with less washing time, dry skin, cost and use of water.
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Affiliation(s)
- Omar Vergara-Fernández
- Departamento de Cirugía. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México, DF.
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Abstract
OBJECTIVE The aim of this paper was to determine whether there is evidence that periodontitis prevention is economically justified. MATERIAL AND METHODS The characteristics of economic assessments such as cost-benefit, cost-effectiveness and cost-utility analyses were first derived from the literature on health economy. A literature search was conducted using PubMed up to December 2004. Inclusion criteria required that economic analyses be based on scientific principles including a hypothesis, valid comparative groups as well as a cost/benefit, cost/effectiveness and cost/utility assessment. RESULTS Only 14 papers were located, which included, in the broadest sense, economic parameters. From these papers, three were systematic reviews, three were randomized controlled studies, four were controlled studies, one was a longitudinal cohort study and three papers were based on statistical modelling. Only one paper reported actual costs for periodontal and dental treatment. Extensive programmes aimed at prevention of periodontal disease in a general population group showed no economic benefit. Adjunctive genetic/and or microbiological testing likewise showed no economic benefit. Economic assessments and real costs are not generally available in the literature. Statistical modelling suggested that non-surgical periodontal procedures are more economical compared with surgical interventions. The use of local delivery devices as an adjunct to Sc/RP showed no economic advantage. CONCLUSION It is suggested that economic parameters as well as patient-centred outcomes be included in clinical trials. These data are essential for the appropriate allocation of resources for preventive measures on an individual patient and population base.
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Affiliation(s)
- Urs Braegger
- Department of Periodontology and Fixed Prosthodontics, School of Dental Medicine, University of Bern, Bern, Switzerland.
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Fong J, Wood F, Fowler B. A silver coated dressing reduces the incidence of early burn wound cellulitis and associated costs of inpatient treatment: Comparative patient care audits. Burns 2005; 31:562-7. [PMID: 15993301 DOI: 10.1016/j.burns.2004.12.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2004] [Accepted: 12/15/2004] [Indexed: 11/24/2022]
Abstract
In 2000 and 2002, the Royal Perth Hospital (RPH) Burn Unit, Western Australia, conducted two 'before and after' patient care audits comparing the effectiveness and cost of Silvazine (silver sulphadiazine and chlorhexidine digluconate cream) and Acticoat, a new dressing product for in-patient treatment of early burn wounds. The main outcome variables were: burn wound cellulitis, antibiotic use and cost of treatment. Two patient care audits and a comparative sample were used. The two regimes audited were, 'standard treatment' of twice daily showers or washes with 4% chlorhexidine soap and Silvazine cream as a topical dressing (2000, n=51), compared with the 'new treatment' of daily showers of the burn wound with 4% chlorhexidine soap and the application of an Acticoat dressing (2002, n=19). In 2002, costs were also examined using a sample of matched pairs (n=8) of current and previous patients. The main findings were: when using Acticoat the incidence of infection and antibiotic use fell from 55% (28/51) and 57% (29/51) in 2000 to 10.5% (2/19) and 5.2% (1/19) in 2002. The total costs (excluding antibiotics, staffing and surgery) for those treated with Silvazine were US$ 109,357 and those treated with Acticoat were US$ 78,907, demonstrating a saving of US$ 30,450 with the new treatment. The average length of stay (LOS) in hospital was 17.25 days for the Silvazine group and 12.5 days for the Acticoat group-a difference of 4.75 days. These audits demonstrate that Acticoat results in a reduced incidence of burn wound cellulitis, antibiotic use and overall cost compared to Silvazine in the treatment of early burn wounds.
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Affiliation(s)
- J Fong
- Burn Unit, Royal Perth Hospital, Wellington Street, G.P.O. Box X2213, Perth, WA 6847, Australia.
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Robins K, Wilson R, Watkins EJ, Columb MO, Lyons G. Chlorhexidine spray versus single use sachets for skin preparation before regional nerve blockade for elective caesarean section: an effectiveness, time and cost study. Int J Obstet Anesth 2005; 14:189-92. [PMID: 15935648 DOI: 10.1016/j.ijoa.2005.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Revised: 02/01/2005] [Accepted: 02/01/2005] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The importance of skin preparation before regional nerve blockade to prevent infection remains unchallenged. A multi-use spray chlorhexidine may have benefits over single use sachets in terms of convenience and cost, but its efficacy is unknown. We conducted a prospective randomised trial to compare spray and sachet chlorhexidine. METHODS Elective caesarean section patients were randomised to receive chlorhexidine as a spray (chlorhexidine 0.5% in an alcoholic solution Hydrex DS Derma spray, Adams Healthcare, Leeds, UK) or sachet chlorhexidine (chlorhexidine 0.05% aqueous solution, Unisept, Seton. Leeds, UK) before a standardised combined spinal epidural technique. Skin colonisation was examined before skin preparation and again after epidural catheter removal. RESULTS Both techniques were effective in reducing skin colonisation (P=0.0001). There was no difference in effectiveness between the groups, with the spray reducing skin colonisation from 88.5% before to 3% after catheter removal, compared with 90% to 12% in the sachet group. Time to achieve skin preparation was significantly reduced in the spray group (2.6 min compared to 4.5 min; P=0.02). The spray cost per patient was 0.01 compared to sachet 0.33. CONCLUSIONS We suggest a chlorhexidine spray is as effective as single use sachets and is also quicker to apply and less costly.
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Affiliation(s)
- K Robins
- Department of Obstetric Anaesthesia, St. James's University Hospital, Leeds, UK.
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Chaiyakunapruk N, Veenstra DL, Lipsky BA, Sullivan SD, Saint S. Vascular catheter site care: the clinical and economic benefits of chlorhexidine gluconate compared with povidone iodine. Clin Infect Dis 2003; 37:764-71. [PMID: 12955636 DOI: 10.1086/377265] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2003] [Accepted: 05/06/2003] [Indexed: 12/13/2022] Open
Abstract
The use of chlorhexidine gluconate solution for vascular catheter insertion site care reduces the risk of catheter-related bloodstream infection by one-half, compared with povidone iodine. Our objective was to evaluate the cost-effectiveness of chlorhexidine gluconate versus povidone iodine. We used data from randomized, controlled trials, meta-analyses, and epidemiologic studies to construct a decision analysis model. We estimated that use of chlorhexidine, rather than povidone, for central catheter site care resulted in a 1.6% decrease in the incidence of catheter-related bloodstream infection, a 0.23% decrease in the incidence of death, and savings of 113 dollars per catheter used. For peripheral catheter site care, the results were similar, although the differences were smaller. The results were found to be robust on multivariate sensitivity analyses. Use of chlorhexidine gluconate in place of the current standard solution for vascular catheter site care is a simple and cost-effective method of improving patient safety in the hospital setting.
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Affiliation(s)
- Nathorn Chaiyakunapruk
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA 98195-7630, USA
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Marciante KD, Veenstra DL, Lipsky BA, Saint S. Which antimicrobial impregnated central venous catheter should we use? Modeling the costs and outcomes of antimicrobial catheter use. Am J Infect Control 2003; 31:1-8. [PMID: 12548250 DOI: 10.1067/mic.2003.35] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Catheter-related bloodstream infections are costly and associated with substantial morbidity and mortality. Trials suggest that central venous catheters impregnated with minocycline/rifampin, although more expensive, are clinically superior to chlorhexidine/silver sulfadiazine impregnated catheters. It remains unclear whether minocycline/rifampin catheters are cost-effective for all high-risk patients or only those requiring longer-term catheterization. METHODS We developed a series of decision models with patient-level clinical trial data to determine whether minocycline/rifampin catheters are cost-effective for patients requiring various durations of catheterization. We calculated incremental cost-effectiveness ratios for patients catheterized for durations ranging from 1 to 25 days. RESULTS The data were too sparse to estimate cost-effectiveness for patients catheterized less than 8 days. The probability that minocycline/rifampin catheters were cost-effective compared with chlorhexidine/silver sulfadiazine catheters in patients catheterized for 8 days was 91%. The probability that the minocycline/rifampin catheters in patients catheterized 13 days or longer resulted in cost savings was more than 95%. CONCLUSIONS Our analysis suggests that central venous catheters coated with minocycline/rifampin are cost-effective for patients catheterized for at least 1 week and lead to overall cost savings when patients are catheterized for 2 weeks or longer. Policies for the use of antimicrobial catheters in high-risk patients should reflect patients' expected duration of catheterization.
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Affiliation(s)
- Kristin D Marciante
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle WA 98195, USA
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Henke CJ, Villa KF, Aichelmann-Reidy ME, Armitage GC, Eber RM, Genco RJ, Killoy WJ, Miller DP, Page RC, Polson AM, Ryder MI, Silva SJ, Somerman MJ, Van Dyke TE, Wolff LF, Evans CJ, Finkelman RD. An economic evaluation of a chlorhexidine chip for treating chronic periodontitis: the CHIP (chlorhexidine in periodontitis) study. J Am Dent Assoc 2001; 132:1557-69. [PMID: 11806071 DOI: 10.14219/jada.archive.2001.0091] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The authors previously suggested that an adjunctive, controlled-release chlorhexidine, or CHX, chip may reduce periodontal surgical needs at little additional cost. This article presents an economic analysis of the CHX chip in general dental practice. METHODS In a one-year prospective clinical trial, 484 chronic periodontitis patients in 52 general practices across the United States were treated with either scaling and root planing, or SRP, plus any therapy prescribed by treating, unblinded dentists; or SRP plus other therapy as above but including the CHX chip. Economic data were collected from bills, case report forms and 12-month treatment recommendations from blinded periodontist evaluators. RESULTS Total dental charges were higher for SRP + CHX chip patients vs. SRP patients when CHX chip costs were included (P = .027) but lower when CHX chip costs were excluded (P = .012). About one-half of the CHX chip acquisition cost was offset by savings in other charges. SRP + CHX chip patients were about 50 percent less likely to undergo surgical procedures than were SRP patients (P = .021). At the end of the trial, periodontist evaluators recommended similar additional procedures for both groups: SRP, about 46 percent; maintenance, about 37 percent; surgery, 56 percent for SRP alone and 63 percent for SRP + CHX chip. CONCLUSIONS Adjunctive CHX chip use for general-practice patients with periodontitis increased costs but reduced surgeries over one year. At study's end, periodontists recommended similar additional surgical treatment for both groups. CLINICAL IMPLICATIONS In general practice, routine use of the CHX chip suggests that costs will be partially offset by reduced surgery over at least one year.
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Affiliation(s)
- C J Henke
- Department of Oral Biology, State University of New York at Buffalo, USA
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Loran OB, Pushkar' DI, Avetisian MM, Rasner PI. [Pharmacological and cost effectiveness bases of the use of categel and categel S [correction of F] in urological practice]. Urologiia 2001:13-7. [PMID: 11490709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Preparations catedgel and catedgel S made in Austria (Montavit) was tried in Moscow hospital N 50. Categel is a sterile gel of methylcellulose with 2% lidocain and 0.05% chlorhexidine, catedgel S contains the same components but lidocain. Categel significantly reduces the risk of infectious-inflammatory complications after endourological manipulations, improves endoscopic diagnosis and makes some manipulations less painful. Comparative pharmacological cost-effect assessment of categel S and glycerine effects in prostatic transurethral resection. Categel was found 2.11 times more effective. It also improves quality of life of the patients. Categel can be recommended for wide use in urology.
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Maki DG, Stolz SM, Wheeler S, Mermel LA. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. A randomized, controlled trial. Ann Intern Med 1997; 127:257-66. [PMID: 9265424 DOI: 10.7326/0003-4819-127-4-199708150-00001] [Citation(s) in RCA: 486] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bloodstream infection related to short-term use of noncuffed central venous catheters is a common and serious problem. Technologic innovations to reduce the risk for these infections are needed. OBJECTIVE To determine 1) the efficacy of a novel antiseptic catheter in preventing central venous catheter-related infection, 2) patient tolerance of this catheter, and 3) the sources of bloodstream infection originating from noncuffed, multilumen central venous catheters. DESIGN Randomized, controlled clinical trial. SETTING Medical-surgical intensive care unit of a 450-bed university hospital. PARTICIPANTS 158 adults scheduled to receive a central venous catheter; 403 catheters were studied. INTERVENTION Participants received either a standard triple-lumen polyurethane catheter or a catheter that was indistinguishable from the standard catheter and was impregnated with chlorhexidine and silver sulfadiazine. MEASUREMENTS Catheters were studied for colonization and catheter-related bloodstream infection at removal; local and systemic effects of catheters were assessed. The origin of each catheter-associated bloodstream infection was sought by culturing all potential sources (skin, catheter segments, hubs, and infusate) and confirmed by restriction-fragment DNA subtyping. RESULTS Antiseptic catheters were less likely to be colonized at removal than control catheters (13.5 compared with 24.1 colonized catheters per 100 catheters; relative risk, 0.56 [95% CI, 0.36 to 0.89]; P = 0.005) and were nearly fivefold less likely to produce bloodstream infection (1.0 compared with 4.7 infections per 100 catheters; 1.6 compared with 7.6 infections per 1000 catheter-days; relative risk, 0.21 [CI, 0.03 to 0.95]; P = 0.03). In the control group, 8 catheter-related bloodstream infections were caused by Staphylococcus aureus, gram-negative bacilli, enterococci, or Candida species; no infections with these organisms occurred in the antiseptic catheter group (P = 0.003). No adverse effects from the antiseptic catheter were seen, and none of the 122 isolates obtained from infected catheters in either group showed in vitro resistance to chlorhexidine-silver sulfadiazine. Cost-benefit analysis indicated that the antiseptic catheter should prove cost-beneficial if an institution's rate of catheter-related bacteremia with noncuffed central venous catheters is at least 3 infections per 1000 catheter-days). CONCLUSIONS The chlorhexidine-silver sulfadiazine catheter is well tolerated, reduces the incidence of catheter-related infection, extends the time that noncuffed central venous catheters can be safely left in place for the short term, and should allow cost savings.
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Affiliation(s)
- D G Maki
- University of Wisconsin Hospital and Clinics-H4/574, Madison 53792, USA
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Lewis DW. Another update for Canadian dentists regarding chlorhexidine varnish therapy for the prevention of dental caries. J Can Dent Assoc 1994; 60:717-725. [PMID: 8087680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Some of the reasons for my belief that CVT has been marketed prematurely have been described. They include the belief that the only really important outcome from the patients' and dentists' perspectives is proven reductions in dental caries. Associated with this is the need to recognize that, using such a criterion, the numbers of patients who may truly benefit from CVT in Canada are small--much smaller than those who promote the testing for and use of CVT appear to infer. Once proven clinically effective, the cost effectiveness of CVT for different patient groups must be demonstrated. I also think that studies to determine Cariescreen's accuracy in terms of predictive values for the "gold standard" plate counts of mutans streptococci should be undertaken. These results should then be given to dentists to help them in their decisions about using CVT in their practices, and if this decision is affirmative, in their discussions with patients for whom they decide CVT will be beneficial. Similarly, the effectiveness of the single application of CVT must be proven by a properly-designed study, since the current justification is inadequate for so important an issue. Finally, dentists should have been provided with all of this basic information before CVT was marketed in Canada.
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Affiliation(s)
- D W Lewis
- Department of Community Dentistry, University of Toronto
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Gisselsson H, Birkhed D, Björn AL. Effect of a 3-year professional flossing program with chlorhexidine gel on approximal caries and cost of treatment in preschool children. Caries Res 1994; 28:394-9. [PMID: 8001065 DOI: 10.1159/000262008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The aim was to evaluate the effect of chlorhexidine gel treatment on the incidence of approximal caries in preschool children. One hundred and seventeen 4-year-olds, divided into two groups, participated: (1) chlorhexidine gel group (n = 59), and (2) placebo gel group (n = 58). Group 1 was treated 4 times a year with a 1% chlorhexdine gel and group 2 with a placebo gel. Approximately 0.7 ml of gel was applied interdentally by means of a flat dental floss. A control group (group 3), which did not receive any flossing or gel treatment, was also included in the study (n = 116). After 3 years, i.e. when the children were 7 years old, the mean incidence of caries on approximal surfaces (defs), including both enamel and dentin lesions, was 2.59 in the chlorhexidine gel, 4.53 in the placebo gel and 4.20 in the control group (group 1 vs. 2 and group 1 vs. 3: p < 0.01). Mean number of approximal fillings at the end of the study, i.e. when the children were 7 years old, was 0.33 in the chlorhexidine gel, 1.04 in the placebo gel and 0.80 in the control group (group 1 vs. 2: p < 0.01; group 1 vs. 3: p < 0.05). The progression of approximal caries lesions, diagnosed on bitewing radiographs from the age of 5 to 7, was slower in the chlorhexidine than in the placebo gel group (the control group was not evaluated in this respect). A cost analysis, based on the total treatment time in minutes, showed a small gain for the flossing program.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Gisselsson
- Department of Cariology, Faculty of Odontology, Göteborg University, Sweden
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Lynch W, Davey PG, Malek M, Byrne DJ, Napier A. Cost-effectiveness analysis of the use of chlorhexidine detergent in preoperative whole-body disinfection in wound infection prophylaxis. J Hosp Infect 1992; 21:179-91. [PMID: 1353510 DOI: 10.1016/0195-6701(92)90074-v] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A total of 3482 general surgical patients entered a trial in which they had a chlorhexidine or placebo detergent shower three times before elective clean wound or potentially contaminated surgery. Patients who showered with a chlorhexidine detergent (N = 1744) had a significant reduction in skin flora compared with those who showered with a placebo detergent (N = 1738). The majority of wound infections occurred outside hospital (312 outpatient infections vs. 201 inpatient infections). Wound infection rates were similar in the chlorhexidine and placebo groups (5.79% vs. 5.75% for inpatient infections and 8.54% vs. 9.38% for outpatient infections). The average hospital cost of both non-infected and infected patients was higher in the chlorhexidine group. The average cost of a non-infected chlorhexidine patient was 847.95 pounds as opposed to 804.60 pounds for a non-infected placebo patient, whilst the average cost of an infected patient was 1459.70 pounds (chlorhexidine) and 1414.22 pounds (placebo). A cross-match comparison of patients undergoing vascular surgery revealed no statistical significance in the difference between the two experimental groups. Patients were matched for age, sex, type of operation and surgeon. We conclude that preoperative whole-body disinfection with a chlorhexidine detergent is not a cost-effective treatment for reducing wound infection.
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Affiliation(s)
- W Lynch
- Pharmacoeconomics Research Centre, University of Dundee, Scotland, UK
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