• D L Veenstra, S Saint, and S D Sullivan.
• Pharmaceutical Outcomes Research and Policy Program and Department of Pharmacy, University of Washington, Seattle 98195-7630, USA. veenstra@u.washington.edu
• JAMA. 1999 Aug 11; 282 (6): 554-60.

ContextA recent randomized controlled trial and meta-analysis indicated that central venous catheters impregnated with an antiseptic combination of chlorhexidine and silver sulfadiazine are efficacious in reducing the incidence of catheter-related bloodstream infection (CR-BSI); however, the ultimate clinical and economic consequences of their use have not been formally evaluated.ObjectiveTo estimate the incremental clinical and economic outcomes associated with the use of antiseptic-impregnated vs standard catheters.DesignDecision analytic model using data from randomized controlled trials, meta-analyses, and case-control studies, as well as safety data from the US Food and Drug Administration.Setting And PatientsA hypothetical cohort of hospitalized patients at high risk for catheter-related infections (eg, patients in intensive care units, immunosuppressed patients, and patients receiving total parenteral nutrition) requiring use of a central venous catheter.InterventionShort-term use (2-10 days) of chlorhexidine-silver sulfadiazine-impregnated multilumen central venous catheters and nonimpregnated catheters.Main Outcome MeasuresExpected incidence of CR-BSI and death attributable to antiseptic-impregnated and standard catheter use; direct medical costs for both types of catheters.ResultsIn the base-case analysis, use of antiseptic-impregnated catheters resulted in a decrease in the incidence of CR-BSI of 2.2% (5.2% for standard vs 3.0% for antiseptic-impregnated catheters), a decrease in the incidence of death of 0.33% (0.78% for standard vs 0.45% for antiseptic-impregnated), and a decrease in costs of $196 per catheter used ($532 for standard vs $336 for antiseptic-impregnated). The decrease in CR-BSI ranged from 1.2% to 3.4%, the decrease in death ranged from 0.09% to 0.78%, and the costs saved ranged from $68 to $391 in a multivariate sensitivity analysis.ConclusionOur analyses suggest that use of chlorhexidine-silver sulfadiazine-impregnated central venous catheters in patients at high risk for catheter-related infections reduces the incidence of CR-BSI and death and provides significant saving in costs. Use of these catheters should be considered as part of a comprehensive nosocomial infection control program.

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