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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*
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 (RRB16@pitt.edu)

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
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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