【推荐】洗必泰浸渍的海绵对导管相关血流感染预防的成本效益分析[全文在8楼]

蓝鱼o_0

Economic evaluation of chlorhexidine-impregnated sponges for preventing catheter-related infections in critically ill adults in the Dressing Study

Background: The randomized two-way factorial Dressing Study (1,636 patients, 28,931 catheter days) showed that a chlorhexidine- impregnated sponge decreased the incidence of major catheter-related infections from 1.4‰ to 0.6‰ catheter days, and that scheduled dressing changes every 7 days was not inferior to scheduled changes every 3 days. Here, we assessed the cost benefits of chlorhexidine-impregnated sponge use.
Methods: Costs directly related to major catheter-related infections and the costs of chlorhexidine-impregnated sponge and
contact dermatitis were calculated prospectively using microcosting methods during the original study. The added length of stay in the intensive care unit due to major catheter-related infection was estimated using the disability model and assuming a cost of $2118/intensive care unit day. The cost of each strategy was estimated based on all costs and on the probability of major catheter-related infection according to the Dressing Study results.
Interventions: None.
Results: Median direct cost of major catheter-related infection was $792. Estimated added length of stay due to major catheterrelated infection was 11 days (95% confidence interval [
2 days;26 days]). Overall cost of major catheter-related infection was $24,090/episode. Each dressing cost $9.08 (146 observations) and each chlorhexidine-impregnated sponge cost $9.73. Assuming a baseline major catheter-related infection incidence of 1.4‰ catheter days, chlorhexidine-impregnated sponge use saved $197 per patient with the 3-day chlorhexidine-impregnated sponge dressing change strategy, and $83 with the 7-day standard dressing change strategy. Chlorhexidine-impregnated sponge use remained cost saving assuming a baseline major catheter-related infection incidence as low as 0.35‰ catheter days, or an overall cost per major catheter-related infections of up to $4400.
Conclusion: Chlorhexidine-impregnated sponge for arterial and central venous catheters saves money by preventing major catheter-related infections, even in intensive care units with low baseline major catheter-related infection levels.
Trial Registration: Clinicaltrials.gov number, NCT00417235. (Crit Care Med 2012; 40:000–000)
KEY WORDS: antiseptic dressings; catheter-related infections;
economic evaluation; intensive care unit

蓝鱼o_0

【摘要】  

【研究背景】随机双阶研究（1636例患者，28931导管日）研究表明，洗必泰浸渍海绵可以CR-BSI的发病率从1.4‰降低到0.6‰，定期换药，每隔7天换一次辅料与预期的三天更换效果没有明显差别。在这里，我们评估洗必泰浸渍海绵使用的成本效益。
【方法】在本次研究中，主要导管相关性感染的直接成本和洗必泰浸渍海绵引起的接触性皮炎的成本和费用由微观成本计算方法前瞻性获得。使用的残差模型估计，由CR-BSI增加的ICU滞留时间假设为2118美元/每ICU日。根据不同臂（双臂，两种方式）的CR-BSI引起的成本。指标CR-BSI。

【干预】无。

【结果】主要导管相关性感染的直接成本中位数为792美元。由于主要CR-BSI引起的ICU滞留时间为11天。所有的CR-BSI病患样本总费用为24090美元。每次换药费用9.08美元（146次观察），每个洗必泰浸渍海绵耗资9.73美元。假设基线的感染率以1.4‰计算，洗必泰浸渍海绵使用保存为期3天和期7天的两种策略分别可以节省83和197美元。如果以0.35‰导管日作为基线，洗必泰浸渍海绵能够节省4400美元。
【结论】洗必泰浸渍海绵处理的动脉和中心静脉导管可以防止导管相关性感染，节省成本，即时是在基线感染水准很低的ICU也能起到效果。

                     

天天，天蓝

版主老师总是提供一些外文资料供大家学习参考，谢谢！

szylh

谢谢版主，不但经常提供新资料，还不厌其烦的翻译好了，真是太感谢了。论坛给我们提供了极其丰富的学习机会，给我们的成长提供了丰富的营养，谢谢了。

四叶草

蓝鱼o_0 发表于 2011-10-12 15:40

                               
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【摘要】  
【研究背景】随机双阶研究（1636例患者，28931导管日）研究表明，洗必泰浸渍海绵可以CR-BSI的发 ...

敢问版主，是否可以这样理解，用洗必泰浸渍海绵定期消毒动脉和中心静脉导管，可以防止导管相关性感染？

蓝鱼o_0

aqyyjyl1972 发表于 2011-10-12 19:49

                               
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敢问版主，是否可以这样理解，用洗必泰浸渍海绵定期消毒动脉和中心静脉导管，可以防止导管相关性感染？

这是毫无疑问的，BUNDLE里面的重要措施之一。都是EVIDENCE BASED

毛豆豆

蓝鱼o_0 发表于 2011-10-12 15:40

                               
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【摘要】  
【研究背景】随机双阶研究（1636例患者，28931导管日）研究表明，洗必泰浸渍海绵可以CR-BSI的发 ...

每个洗必泰浸渍海绵耗资9.73美元，不知道这里是不是包含人工成本，还有流程改变后间接产生的成本呢？

蓝鱼o_0

毛豆豆 发表于 2011-10-13 16:06

                               
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每个洗必泰浸渍海绵耗资9.73美元，不知道这里是不是包含人工成本，还有流程改变后间接产生的成本呢？

终于遇到一个感兴趣的人了，好吧，上传全文。
看您是有缘人，赠与您了。哈哈

毛豆豆

蓝鱼o_0 发表于 2011-10-13 16:11

                               
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终于遇到一个感兴趣的人了，好吧，上传全文。
看您是有缘人，赠与您了。哈哈

大家一起分享，这样才能有火花吗！看来下手晚了，已经有六人下载了。

lacegong

是残差模型吗……还是我理解错了，貌似没听说过残疾模型

蓝鱼o_0

lacegong 发表于 2011-11-30 10:52

                               
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是残差模型吗……还是我理解错了，貌似没听说过残疾模型

您很幽默。谢谢您的指正。确实是我打字太快弄错了。摘要是快译，难免疏忽，请谅解！
请继续支持，多多提点！

xingxing1988

蓝鱼大大真是好人呐，