OBJECTIVES

Surgical site infection (SSI) is one of the most common healthcare-associated infections. In Australia, the prevalence of SSI in Caesarean deliveries is 2.1% (amongst 104,984 deliveries/year). This study aims to compare costs and SSI outcomes between adopting sterile alcoholic chlorhexidine gluconate (CHG) solution in a pre-filled applicator versus bulk aqueous povidone iodine (PVI) solution for preoperative skin preparation in Caesarean deliveries in a public hospital setting.

METHODS

A budget impact tool, developed in Microsoft Excel, evaluates the clinical and economic impact of skin preparation methods and associated SSI rates (including antiseptic and treatment costs and length of stay). Both global and local peer-reviewed data inform SSI rates and additional length of stay for SSI. PVI SSI rate is assumed as the baseline rate observed in Australia (2.1%). CHG SSI rate is derived by applying the previously demonstrated CHG SSI reduction versus PVI (42%) to the PVI SSI rate. Local cost data is utilised: CHG antiseptic cost is AU$9.90 and PVI is AU$3.00. Additionally, PVI equipment costs AU$2.13. Clinical waste disposal cost is assumed as AU$0.07 for CHG and AU$0.11 for PVI. Additional average length of stay for SSI is 2.1 days and average cost per additional day is AU$2,074.

RESULTS

The model estimates an SSI rate of 1.2% for CHG, compared to 2.1% for PVI. For every 1,000 patients, skin preparation cost is estimated to be AU$9,972 using CHG and AU$5,236 using PVI. SSI treatment cost is estimated to be AU$20,688 for CHG and AU$35,669 for PVI. 18 bed-days can be avoided and 80 operating theatre-hours can be saved performing skin preparation using CHG compared with PVI.

CONCLUSIONS

Using CHG applicator as the skin preparation method prior to Caesarean deliveries can result in lower SSI rates and cost savings from treating fewer SSIs. Operational efficiency may also be achieved.