Session number: 1072
Abstract title: Which Disinfectant Should We Use for Vascular Catheter Site Care: Chlorhexidine or Povidone-Iodine?
Author(s):
S SAINT - Ann Arbor VAMC and University of Michigan
N CHAIYAKUNAPRUK - University of Washington
BA LIPSKY - Seattle VAMC and University of Washington
SD SULLIVAN - University of Washington
DL VEENSTRA - University of Washington
Objectives: Intravascular catheters are commonly used in caring for hospitalized patients and often lead to catheter-related bloodstream infection (CR-BSI). Using antiseptic solutions for skin disinfection at the catheter site helps prevent infection. While povidone-iodine solution (PI) is the most commonly used skin disinfectant, our recent meta-analysis of 8 trials indicates that chlorhexidine gluconate solution (CHG) is superior for catheter site care. It remains unclear whether the additional benefit of CHG is worth the extra cost. We sought to aid decision-makers by determining the clinical and economic consequences associated with the use of CHG compared to PI for vascular catheter site care.
Methods: We constructed a decision analytic model using data from randomized controlled trials, meta-analyses, and epidemiological studies. We used a hypothetical cohort of hospitalized patients requiring peripheral or central vascular catheter access for less than 10 days who were given either CHG or PI for site care. The incidence of CR-BSI, death attributable to CR-BSI, and direct medical costs were the primary outcomes. We performed the analysis using the perspective of a healthcare payer; the time horizon was the period of hospitalization.
Results: In the base-case analysis, using CHG for central catheter site care resulted in an absolute decrease in the incidence of CR-BSI of 1.6% (3.1% for PI vs. 1.5% for CHG) and death of 0.23% (0.46% for PI vs. 0.23% for CHG), and a reduction in total health care costs of $113 per catheter used. In a multivariate sensitivity analysis, the decrease in CR-BSI ranged from 0.6% to 2.5%, the decrease in death ranged from 0.07% to 0.47%, and the cost savings ranged from $18 to $241. Using CHG for peripheral vascular catheter site care decreased the incidence of CR-BSI by 0.5% (range, 0.1% to 1.2%) and death by 0.005% (range, 0.001% to 0.015%), while also reducing total costs by $8 (range, $2 to $20) per catheter used.
Conclusions: Using CHG for vascular catheter site skin disinfection is a straightforward and effective method of enhancing patient safety, while also reducing healthcare costs.
Impact statement: The Department of Veterans Affairs may be able to save lives and money by simply changing the antiseptic solution used for routine vascular site care.