OBJECTIVES: Surgical site infections (SSI) represent one of the most frequent hospital acquired infections, and are associated with patient morbidity, excess mortality, longer inpatient stays, and increased costs. Skin preparation with 2% chlorhexidine gluconate (w/v) in 70% isopropyl alcohol in a single use applicator, has been found to lead to a statistically significant reduction in SSI rates compared with other antiseptics. An economic analysis has been developed on the basis of these clinical results to compare the cost impact of different skin preparation solutions from the perspective of Italian hospitals.

METHODS: A decision tree model has been developed to compare the costs of 2% chlorhexidine gluconate (w/v) in 70% isopropyl alcohol in a single use applicator with povidone iodine (aqueous and alcoholic) in a generic cohort of 1’000 patients undergoing surgery per year. Costs and rates of SSI were retrieved from the wider literature. The robustness of the results were tested with univariate sensitivity analysis.

RESULTS: Over a cohort of 1’000 patients, 2% chlorhexidine gluconate (w/v) in 70% isopropyl alcohol yearly prevents 26 SSIs compared with povidone iodine alcoholic, and 66 SSIs compared with povidone iodine aqueous. This equates to savings of €120 and €318 per patient respectively in hospitals and a total saving of €120’000 and €318’000 per year for the full cohort. The sensitivity analysis demonstrates that the rate of SSIs is the key driver of the analysis.

CONCLUSIONS: The choice of the most effective agent for skin preparation, together with the implementation of a cohesive strategy against SSIs, can lead hospitals to reduce the clinical and economic burden of infections.