Chlorhexidine-silver sulfadiazine-impregnated venous catheters are efficient even at subclavian sites without tracheostomy

Abstract

Chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters have been found to decrease the risk of catheter-related bloodstream infection (CRBSI) and central venous catheter (CVC)-related costs. However, there are no published data about cost-effectiveness of the use of CHSS-impregnated catheters in subclavian venous access without the presence of tracheostomy (thus, with a very low risk of CRBSI). That was the objective of this study. This was a retrospective study of patients admitted to a mixed intensive care unit who underwent placement of subclavian venous catheters without the presence of tracheostomy. Patients with standard catheters (n = 747) showed a higher CRBSI incidence density (0.95 vs 0/1,000 catheter-days; P = .02) and higher CVC-related cost per day ($3.78 ± $7.43 vs $3.31 ± $2.72; P < .001) than patients with a CHSS-impregnated catheter (n = 879). Exact logistic regression analysis showed that catheter duration (P = .02) and the type of catheter used (P = .01) were associated with the risk of CRBSI. Kaplan-Meier method showed that CHSS-impregnated catheters were associated with more prolonged CRBSI-free time than standard catheters (log-rank = 9.76; P = .002). Poisson regression analysis showed that CHSS-impregnated catheters were associated with a lower central venous catheter-related cost per day than standard catheters (odds ratio, 0.87; 95% confidence interval, 0.001-0.903; P < .001). The use of CHSS-impregnated catheters is an effective and efficient measure for the prevention of CRBSI even at subclavian venous access sites without the presence of tracheostomy.