cost-effectiveness of a central venous catheter care bundle成本效益的中心静脉导管护理包.pdf

Cost-Effectiveness of a Central Venous Catheter Care Bundle 1,2 3 1,4 5 1,2 Kate A. Halton *, David Cook , David L. Paterson , Nasia Safdar , Nicholas Graves 1The Centre for Healthcare Related Infection Surveillance and Prevention, Brisbane, Queensland, Australia, 2 Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia, 3 Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia, 4 University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia, 5 Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America Abstract Background: A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI). Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. Methods and Findings: A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters), or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncer