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Universal vs Targeted Chlorhexidine Bathing and Nasal Decolonization in Hospitalized Patients.

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Summary

Targeted decolonization (TD) is the most cost-effective strategy to reduce hospital-onset bacteremia and fungemia (HOB) compared to universal decolonization (UD) or standard of care (SOC). UD may be cost-effective in specific scenarios with high rates of medical device use.

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Area of Science:

  • Infection Control
  • Health Economics
  • Clinical Microbiology

Background:

  • Hospital-onset bacteremia and fungemia (HOB) pose significant risks to patient safety and increase healthcare costs.
  • Previous research, like the ABATE Infection trial, showed universal decolonization (UD) reduced HOB but did not clarify cost-effectiveness.
  • Non-intensive care unit settings require evaluation of different decolonization strategies to optimize patient outcomes and resource allocation.

Purpose of the Study:

  • To compare the cost-effectiveness of universal decolonization (UD), targeted decolonization (TD), and standard of care (SOC) for preventing HOB in general medical and surgical units.
  • To analyze costs from both payer and hospital perspectives.
  • To identify the most economically viable strategy for reducing HOB events.

Main Methods:

  • A decision analytic model simulated over 500,000 participants from the ABATE Infection trial.
  • Three strategies were modeled: SOC, UD, and TD (decolonization for patients with medical devices only).
  • Costs included upstream bathing expenses and downstream HOB treatment, with willingness-to-pay thresholds set at $25,000 (payer) and $10,000 (hospital) per HOB averted.

Main Results:

  • The standard of care (SOC) was the least effective and most costly strategy.
  • Targeted decolonization (TD) was the least costly overall and demonstrated cost-effectiveness from both payer and hospital perspectives.
  • Universal decolonization (UD) resulted in the fewest HOB events but had higher incremental cost-effectiveness ratios compared to TD.

Conclusions:

  • Targeted decolonization (TD) is the preferred cost-effective strategy for reducing HOB across a wide range of scenarios for both payers and hospitals.
  • Universal decolonization (UD) may be cost-effective in specific situations, such as units with a high proportion of patients with medical devices or when implementing TD is challenging.
  • The findings support the implementation of TD as a primary strategy to manage HOB while optimizing healthcare expenditures.