Uso di clorexidina 2% in soluzione alcolica al 70% con applicatore monouso per la prevenzione delle infezioni da sito chirurgico in cardiochirurgia: uno studio di budget impact
Antonio Capo, Nicoletta Barzaghi, Claudio Grossi
Introduction The adverse effects of healthcare associated infections (HAIs) are considerable: 37,000 deaths in Europe in 2008 with an increase in expenditure of about 7 billion euros and about 16 million additional days of hospitalization. In cardiac surgery wound infection can still today have a lethal evolution up to the 30% of the cases. Particular importance in prevention is the definition of adequate path diagnostic therapeutic care (PDTA) and operating room bundles. In 2015, following the review of international literature, the operating theatre bundle of “Santa Croce e Carle” hospital in Cuneo changed, replacing the acqueous povidone iodine with 2% chlorhexidine/70% isopropyl alcohol (2% CHG/70% IPA), in a single-use sterile applicator.
The aim of the study was to evaluate the clinical and budget impact of 2% CHG/70% IPA in a single-use sterile applicator in the Cardiac Surgery Department, by comparing the rate of infection pre and post the introduction of the new antiseptic solution (490 patients in the year before and 469 in the year after).
Results Surgical wound dehiscences, even if starting from a contained incidence of 2%, fell to 1% (10 in the year pre introduction of the new antiseptic vs 5 in the year after the new bundle) and in the observed period there were no infections of the surgical site. The 4 patients in the control group who had a surgical site infection, consumed 166 days of hospitalization for a total cost of about € 260,000, with an increase of about € 225,000 in comparison with similar patients without surgical complication. Adherence to PDTA for wound management was substantially overlapping for all patients with the exception of the time interval between the appearance of the first clinical signs and the start of negative pressure therapy: 7 days (8-6) in patients who died compared to 3 days (1-5) of surviving patients. With the introduction of the new antiseptic, the costs for disinfectants have increased. However, additional expenditure was offset by the savings for high-cost antibiotics.
Conclusions The introduction of 2% CHG/70% IPA in a single-use sterile applicator in the preparation of the patient has brought significant benefits both from the clinical point of view with the elimination of the cases of infection and the economic with a significant net saving.
Further improvements could perhaps have been achieved with closer respect of the PDTA.
Key words: cardiac surgery, chlorhexidine, surgical site infection, budget impact