Chlorhexidine versus saline in reducing the risk of catheter associated urinary tract infection : A cost-effectiveness analysis

Journal article

Mitchell, Brett G., Fasugba, Oyebola, Cheng, Allen C., Gregory, Victoria, Koerner, Jane, Collignon, Peter, Gardner, Anne and Graves, Nicholas. (2019). Chlorhexidine versus saline in reducing the risk of catheter associated urinary tract infection : A cost-effectiveness analysis. International Journal of Nursing Studies. 97, pp. 1-6. https://doi.org/10.1016/j.ijnurstu.2019.04.003
AuthorsMitchell, Brett G., Fasugba, Oyebola, Cheng, Allen C., Gregory, Victoria, Koerner, Jane, Collignon, Peter, Gardner, Anne and Graves, Nicholas
Abstract

Background
Catheter associated urinary tract infections are one of the most common infections acquired in hospital. A recent randomised control study demonstrated the benefit of using chlorhexidine (0.1%) for meatal cleaning prior to urinary catheter insertion, by reducing both catheter associated asymptomatic bacteriuria and infection. These findings raise the important question of whether a decision to switch from saline to chlorhexidine was likely to be cost-effective. The aim of this paper was to evaluate the cost-effectiveness of adopting routine use of chlorhexidine for meatal cleaning prior to urinary catheter insertion

Methods
The outcomes of this cost-effectiveness study are changes to health service costs in $AUD and changes to quality adjusted life years from a decision to adopt 0.1% chlorhexidine for meatal cleaning prior to urinary catheter insertion as compared to saline. Effectiveness outcomes for this study were taken from a 32 week stepped wedge randomised controlled study conducted in three Australian hospitals.

Results
The changes in health costs from switching from saline to 0.1% chlorhexidine per 100,000 catheterisations would save hospitals AUD$387,909 per 100,000 catherisations, prevent 70 cases of catheter associated urinary tract infections, release 282 bed days and provide a small improvement in health benefits of 1.43 quality adjusted life years. Using a maximum willingness to pay for a marginal quality adjusted life year threshold of AUD$28,000 per 100,000 catherisations, suggests that adopting chlorhexidine would be cost effective and potentially cost-saving.

Conclusion
The findings from our work provide evidence to health system administrators and those responsible for drafting catheter associated urinary tract infections prevention guidelines that investing in switching from saline to chlorhexidine is not only clinically effective but also a sensible decision in the context of allocating finite healthcare resources.

Keywordschlorhexidine; cost-benefit analysis; costs and cost analysis; health services; infection control; nursing; urinary catheters; urinary tract infections
Year2019
JournalInternational Journal of Nursing Studies
Journal citation97, pp. 1-6
PublisherElsevier Ltd
ISSN0020-7489
Digital Object Identifier (DOI)https://doi.org/10.1016/j.ijnurstu.2019.04.003
Scopus EID2-s2.0-85065913793
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-6
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online13 Apr 2019
Publication process dates
Accepted05 Apr 2019
Deposited02 Jun 2021
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Bola, Fasugba,, Gardner, Anne, Mitchell, Brett, Beckingham, Wendy and Bennett, Noleen. (2014). Surveillance to reduce urinary tract infections: the STRUTI project. Australian Nursing and Midwifery Journal. 22(3), pp. 34 - 35.
Healthcare associated urinary tract infections : A protocol for a national point prevalence study
Mitchell, Brett, Gardner, Anne, Beckingham, Wendy and Fasugba, Oyebola. (2014). Healthcare associated urinary tract infections : A protocol for a national point prevalence study. Healthcare Infection. 19(1), pp. 26 - 31. https://doi.org/10.1071/HI13037
Addressing the need for an infection prevention and control framework that incorporates the role of surveillance: A discussion paper
Mitchell, Brett and Gardner, Anne. (2014). Addressing the need for an infection prevention and control framework that incorporates the role of surveillance: A discussion paper. Journal of Advanced Nursing. 70(3), pp. 533 - 542. https://doi.org/10.1111/jan.12193
The Fitzpatrick Skin Type Scale : A reliability and validity study in women undergoing radiation therapy for breast cancer
Fasugba, Oyebola, Gardner, Anne and Smyth, Wendy. (2014). The Fitzpatrick Skin Type Scale : A reliability and validity study in women undergoing radiation therapy for breast cancer. Journal of Wound Care. 23(7), pp. 358 - 368. https://doi.org/10.12968/jowc.2014.23.7.358
Mortality and clostridium difficile infection in an Australian setting
Mitchell, Brett, Gardner, Anne and Hiller, Janet. (2013). Mortality and clostridium difficile infection in an Australian setting. Journal of Advanced Nursing. https://doi.org/10.1111/jan.12078
A survey-based study of knowledge of Alzheimer's disease among health care staff
Smyth, Wendy, Fielding, Elaine, Beattie, Elizabeth, Gardner, Anne, Moyle, Wendy, Franklin, Sara, Hines, Sonia and MacAndrew, Margaret. (2013). A survey-based study of knowledge of Alzheimer's disease among health care staff. BMC Geriatrics. 13(2), pp. 1 - 8. https://doi.org/10.1186/1471-2318-13-2
Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care: An integrative review
Schadewaldt, Verena, McInnes, Elizabeth, Hiller, Janet and Gardner, Anne. (2013). Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care: An integrative review. BMC Family Practice. 14(132), pp. 1 - 11. https://doi.org/10.1186/1471-2296-14-132
Development and interrater reliability testing of a telephone interview training programme for Australian nurse interviewers
Ahern, Tracey, Gardner, Anne, Gardner, Glenn, Middleton, Sandy and Della, Phillip. (2013). Development and interrater reliability testing of a telephone interview training programme for Australian nurse interviewers. Nurse Education Today. 33(5), pp. 470-474. https://doi.org/10.1016/j.nedt.2012.05.001
Centrelink: An innovative urban intervention for improving adult Aboriginal and Torres Strait Islander access to vaccination
Thomsen, Rosie, Smyth, Wendy, Gardner, Anne and Ketchell, Jennifer. (2012). Centrelink: An innovative urban intervention for improving adult Aboriginal and Torres Strait Islander access to vaccination. Infection, Disease and Health. 17(4), pp. 136 - 141. https://doi.org/10.1071/HI12035
Report of a case of neonatal malaria (Plasmodium falciparum) in Nigeria
Fasugba, Oyebola. (2012). Report of a case of neonatal malaria (Plasmodium falciparum) in Nigeria. Healthcare Infection. 17(4), pp. 122 - 126. https://doi.org/10.1071/HI12024
Supporting rural and remote area nurses to utilise and conduct research : An intervention study
Gardner, Anne, Smyth, Wendy, Renison, Bronia, Cann, Tina and Vicary, Mary. (2012). Supporting rural and remote area nurses to utilise and conduct research : An intervention study. Collegian. 19(2), pp. 97 - 105. https://doi.org/10.1016/j.colegn.2011.09.005
Anatomical location of injury in Stage I and Stage II heel pressure injuries : a pilot study
Dunk, Ann Marie, Gardner, Anne and Waddington, Gordon. (2012). Anatomical location of injury in Stage I and Stage II heel pressure injuries : a pilot study. Wound Practice & Research. 20(3), pp. 130 - 141.
Mortality and Clostridium difficile infection: a review
Mitchell, Brett G. and Gardner, Anne. (2012). Mortality and Clostridium difficile infection: a review. Antimicrobial Resistance and Infection Control. 1(1). https://doi.org/10.1186/2047-2994-1-20
Change for the better : An innovative model of care delivering positive patient and workforce outcomes
Cann, Tina and Gardner, Anne. (2012). Change for the better : An innovative model of care delivering positive patient and workforce outcomes. Collegian. 19(2), pp. 107 - 113. https://doi.org/10.1016/j.colegn.2011.09.002
Healthcare-associated infections: Getting the balance right in safety and quality v. public reporting (Review)
Mitchell, Brett, Gardner, Anne and McGregor, Alistair. (2012). Healthcare-associated infections: Getting the balance right in safety and quality v. public reporting (Review). Australian Health Review. 36(4), pp. 365 - 366. https://doi.org/10.1071/AH11200
The epidemiology of Staphylococcus aureus bacteraemia in Tasmania
Mitchell, Brett, Gardner, Anne and Stewart, Lee. (2012). The epidemiology of Staphylococcus aureus bacteraemia in Tasmania. Healthcare Infection. 17(3), pp. 98 - 103. https://doi.org/10.1071/HI12020
Prolongation of length of stay and Clostridium difficile infection : A review of the methods used to examine length of stay due to healthcare associated infections
Mitchell, Brett and Gardner, Anne. (2012). Prolongation of length of stay and Clostridium difficile infection : A review of the methods used to examine length of stay due to healthcare associated infections. Antimicrobial Resistance and Infection Control. 1(14), pp. 1 - 6. https://doi.org/10.1186/2047-2994-1-14
The prevalence of urinary distress in male and female adults with diabetes mellitus attending a Northern Australian endocrine centre
Chadwick, Robyn, Corstiaans, Audrey, Gardner, Anne, Crook, Sandra, Tan, Yong Mong, Rane, Ajay and Millar, Lynne. (2012). The prevalence of urinary distress in male and female adults with diabetes mellitus attending a Northern Australian endocrine centre. Australian and New Zealand Continence Journal. 18(3), pp. 80 - 86.
Irritability :an underappreciated side effect of interferon treatment for chronic hepatitis C?
Blacklaws, Helen, Gardner, Anne and Usher, Kim. (2011). Irritability :an underappreciated side effect of interferon treatment for chronic hepatitis C? Journal of Clinical Nursing. 20, pp. 1215 - 1224. https://doi.org/10.1111/j.1365-2702.2010.03494.x
Audit of factors associated with the intactness of central venous catheter exit site dressings for northern Australian haemodialysis patients
Hughes, K., Gardner, Anne and McArdle, J.. (2011). Audit of factors associated with the intactness of central venous catheter exit site dressings for northern Australian haemodialysis patients. Renal Society of Australasia Journal. 7(3), pp. 108 - 114.
The status of Australian nurse practitioners: The second national census
Middleton, Sandy, Gardner, Anne, Gardner, G. and Della, P R.. (2011). The status of Australian nurse practitioners: The second national census. Australian Health Review. 35(4), pp. 448 - 454. https://doi.org/10.1071/AH10987
A snapshot of Australian nurse practitioners' extended practice activities
Gardner, Glenn, Gardner, Anne, Middleton, Sandy, Della, Phillip and Doubrovsky, Anna. (2010). A snapshot of Australian nurse practitioners' extended practice activities. The Nurse Practitioner Series. 3(1), pp. 8-15.
A literature review supporting the proposed national Australian definition for Staphylococcus aureus bacteraemia
Mitchell, Brett, Gardner, Anne, Collignon, Peter, Stewart, Lee and Cruickshank, Marilyn. (2010). A literature review supporting the proposed national Australian definition for Staphylococcus aureus bacteraemia. Healthcare Infection. 15(4), pp. 105 - 113. https://doi.org/10.1071/HI10030
The work of nurse practitioners
Gardner, Glenn, Gardner, Anne, Middleton, Sandy, Della, Phillip, Kain, Victoria and Doubrovsky, Anna. (2010). The work of nurse practitioners. Journal of Advanced Nursing. 66(10), pp. 2160-2169. https://doi.org/10.1111/j.1365-2648.2010.05379.x
The first Australian nurse practitioner census : A protocol to guide standardized collection of information about an emergent professional group
Middleton, Sandy, Gardner, Glenn, Gardner, Anne, Della, Phillip, Gibb, Michelle and Millar, Lynne. (2010). The first Australian nurse practitioner census : A protocol to guide standardized collection of information about an emergent professional group. International Journal of Nursing Practice. 16(5), pp. 517-524. https://doi.org/10.1111/j.1440-172X.2010.01877.x
Development and validation of a novel approach to work sampling : A study of work practitioner work patterns
Gardner, Glenn, Gardner, Anne, Middleton, Sandy, Gibb, Michelle, Della, Phillip and Duffield, Christine. (2010). Development and validation of a novel approach to work sampling : A study of work practitioner work patterns. Australian Journal of Advanced Nursing. 27(4), pp. 4-12.
Clients' understanding of the role of nurse practitioners
Susan, Allnutt,, Allnutt, Nissa, McMaster, Rose, O'Connell, Jane, Middleton, Sandy, Hillege, Sharon, Della, Phillip R., Gardner, Glenn E. and Gardner, Anne. (2010). Clients' understanding of the role of nurse practitioners. Australian Health Review. 34(1), pp. 59-65. https://doi.org/10.1071/AH09688
The status of Australian nurse practitioners : The first national census
Gardner, Anne, Della, Phillip R., Middleton, Sandy and Gardner, Glenn. (2009). The status of Australian nurse practitioners : The first national census. Australian Health Review. 33(4), pp. 679-689. https://doi.org/10.1071/AH090679
Pressure injury prevalence in a private health service: Risks and recommendations
Gardner, Anne, Millar, Lynne, Legg, Sandra, Gomez, Yvette, McGillion, Tony and Mulcahy, Aidan. (2009). Pressure injury prevalence in a private health service: Risks and recommendations. Wound Practice & Research. 17(3), pp. 134 - 145.
Absolutely fabulous - but are we? Carers' perspectives on satisfaction with a palliative homecare service
O'Connor, Lera, Gardner, Anne, Millar, Lynne and Bennett, Peter. (2009). Absolutely fabulous - but are we? Carers' perspectives on satisfaction with a palliative homecare service. Collegian. 16(4), pp. 201 - 209. https://doi.org/10.1016/j.colegn.2009.04.005
Implementing a journal club in a palliative care setting: A link in the chain of evidence-based practice
O'Connor, Lera, Bennett, Peter, Gardner, Anne, Hawkins, Mary and Wellman, David. (2009). Implementing a journal club in a palliative care setting: A link in the chain of evidence-based practice. Collegian. 16(3), pp. 147 - 152. https://doi.org/10.1016/j.colegn.2008.12.006
A literature review of central venous catheter dressings: Implications for haemodialysis in the tropics
McArdle, Joleen and Gardner, Anne. (2009). A literature review of central venous catheter dressings: Implications for haemodialysis in the tropics. Infection, Disease and Health. 14(4), pp. 139 - 146. https://doi.org/10.1071/HI09014
Excellence in regional stroke care: An evaluation of the implementation of a stroke care unit in regional Australia
McCann, Leanne, Groot, Patrick, Charnley, Chris and Gardner, Anne. (2009). Excellence in regional stroke care: An evaluation of the implementation of a stroke care unit in regional Australia. Australian Journal of Rural Health. 17(5), pp. 273 - 278. https://doi.org/10.1111/j.1440-1584.2009.01098.x
Writing ourselves into a web of obedience: A nursing policy analysis
Bail, Kasia, Cook, Robert, Gardner, Anne and Grealish, Laurie. (2009). Writing ourselves into a web of obedience: A nursing policy analysis. International Journal of Nursing Studies. 46(11), pp. 1457 - 1466. https://doi.org/10.1016/j.ijnurstu.2009.04.005
Potential scope and impact of a transboundary model of nurse practitioners in aged care
Bail, Kasia, Arbon, Paul, Eggert, Marlene, Gardner, Anne, Hogan, Sonia, Phillips, Christine, van Dieman, Nicole and Waddington, Gordon. (2009). Potential scope and impact of a transboundary model of nurse practitioners in aged care. Australian Journal of Primary Health. 15(3), pp. 232 - 237. https://doi.org/10.1071/PY09009
Patients' and nurses' perspectives on oxygen therapy: A qualitative study
Eastwood, Glenn, O'Connell, Beverley, Gardner, Anne and Considine, Julie. (2009). Patients' and nurses' perspectives on oxygen therapy: A qualitative study. Journal of Advanced Nursing. 65(3), pp. 634 - 641. https://doi.org/10.1111/j.1365-2648.2008.04933.x
Reporting a research project on the potential of aged care nurse practitioners in the Australian capital territory
Arbon, Paul, Bail, Kasia, Eggert, Marlene, Gardner, Anne, Hogan, Sonia, Phillips, Christine, van Dieman, Nicole and Waddington, Gordon. (2009). Reporting a research project on the potential of aged care nurse practitioners in the Australian capital territory. Journal of Clinical Nursing. 18(2), pp. 255 - 262. https://doi.org/10.1111/j.1365-2702.2008.02452.x
Selecting the right integration of research into practice strategy
Eastwood, Glenn, O'Connell, Beverley and Gardner, Anne. (2008). Selecting the right integration of research into practice strategy. Journal of Nursing Care Quality. 23(3), pp. 258 - 264. https://doi.org/10.1097/01.NCQ.0000324591.76590.e9
From competence to capability: A study of nurse practitioners in clinical practice
Gardner, Anne, Hase, Stewart, Gardner, Glenn, Dunn, Sandra and Carryer, Jenny. (2008). From competence to capability: A study of nurse practitioners in clinical practice. Journal of Clinical Nursing. 17(2), pp. 250 - 258. https://doi.org/10.1111/j.1365-2702.2006.01880.x
Evaluation of nasopharyngeal oxygen, nasal prongs and facemask oxygen therapy devices in adult patients: A randomised crossover trial
Eastwood, Glenn, O'Connell, Beverley, Gardner, Anne and Considine, Julie. (2008). Evaluation of nasopharyngeal oxygen, nasal prongs and facemask oxygen therapy devices in adult patients: A randomised crossover trial. Anaesthesia and Intensive Care. 36(5), pp. 691 - 694.
The core role of the nurse practitioner: practice, professionalism and clinical leadership
Carryer, Jenny, Gardner, Glenn, Dunn, Sandra and Gardner, Anne. (2007). The core role of the nurse practitioner: practice, professionalism and clinical leadership. Journal of Clinical Nursing. 16(10), pp. 1818 - 1825. https://doi.org/10.1111/j.1365-2702.2007.01823.x
Living with chronic illness
Gardner, Glenn and Gardner, Anne. (2007). Living with chronic illness. In In McAllister, Margaret (Ed.). Solution focused nursing : Rethinking practice pp. 143-153 Palgrave Macmillan.
Dealing with data: optimising data consistency to demonstrate the value of nurse practitioner service
Gardner, Anne, Millar, Lynne and Driscoll, Andrea. (2007). Dealing with data: optimising data consistency to demonstrate the value of nurse practitioner service. The Nurse Practitioner Series. 2(1), pp. 19 - 25.
Intravascular catheter bloodstream infections: An effective and sustained hospital-wide prevention program over 8 years
Collignon, Peter J., eimanis, Dianne E., Beckingham, Wendy D., Roberts, Jan L. and Gardner, Anne. (2007). Intravascular catheter bloodstream infections: An effective and sustained hospital-wide prevention program over 8 years. Medical Journal of Australia. 187(10), pp. 551 - 554.
The capability of nurse practitioners may be diminished by controlling protocols
Carryer, Jenny, Gardner, Glenn, Dunn, Sandra and Gardner, Anne. (2007). The capability of nurse practitioners may be diminished by controlling protocols. Australian Health Review. 31(1), pp. 108 - 115. https://doi.org/10.1071/AH070108
Clinical usefulness and feasibility of using Reality Orientation with patients who have dementia in acute care settings
O'Connell, Beverley, Gardner, Anne, Takase, Miyuki, Hawkins, Mary, Ostaszkiewicz, Joan, Ski, Chantal and Josipovic, Patricia. (2007). Clinical usefulness and feasibility of using Reality Orientation with patients who have dementia in acute care settings. International Journal of Nursing Practice. 13(3), pp. 182 - 192. https://doi.org/10.1111/j.1440-172X.2007.00624.x
Prevalence of genital human papillomavirus DNA in a sample of senior school-aged women in the Australian Capital Territory
O'Keefe, Elissa, Gardner, Anne, Currie, Marian, Garland, Suzanne, Tabrizi, Sepehr and Bowden, Francis. (2006). Prevalence of genital human papillomavirus DNA in a sample of senior school-aged women in the Australian Capital Territory. Sexual Health. 3(2), pp. 91 - 94. https://doi.org/10.1071/SH05047
Competency and capability: imperative for nurse practitioner education
Gardner, Glenn, Carryer, Jenny, Dunn, Sandra and Gardner, Anne. (2006). Competency and capability: imperative for nurse practitioner education. Australian Journal of Advanced Nursing. 24(1), pp. 8 - 14.
Using a monitored sip test to assess risk of aspiration in postoperative patients
Osborne, Sonya, Gardner, Glenn, Gardner, Anne, Franklin, Susan, Tuohy, Elizabeth and Fisher, Alex. (2006). Using a monitored sip test to assess risk of aspiration in postoperative patients. AORN Journal. 83(4), pp. 908 - 928. https://doi.org/10.1016/S0001-2092(06)60010-0
Sedation and analgesia management for mechanically ventilated adults: literature review, case study and recommendations for practice
Feeley, Kathy and Gardner, Anne. (2006). Sedation and analgesia management for mechanically ventilated adults: literature review, case study and recommendations for practice. Australian Critical Care. 19(2), pp. 73 - 77. https://doi.org/10.1016/S1036-7314(06)80012-3
How ophthalmic day surgery patients convalesce at home: an exploration of the salient issues
Ryan, Fiona, O'Connell, Beverley and Gardner, Anne. (2006). How ophthalmic day surgery patients convalesce at home: an exploration of the salient issues. Day Surgery Australia. 5(3), pp. 11 - 16.
Pressure injury: an exploration of the relationship between risk factors and interface pressure
Gardner, Anne, Dunk, Ann Marie, Eggert, Marlene, Gardner, Glenn and Wellman, David. (2006). Pressure injury: an exploration of the relationship between risk factors and interface pressure. Wound Practice & Research. 14(4), pp. 140 - 149.
Nurse Practitioner competency standards: Findings from collaborative Australian and New Zealand research
Gardner, Glenn, Carryer, Jenny, Gardner, Anne and Dunn, Sandra. (2006). Nurse Practitioner competency standards: Findings from collaborative Australian and New Zealand research. International Journal of Nursing Studies. 43(5), pp. 601 - 610. https://doi.org/10.1016/j.ijnurstu.2005.09.002
A trial of nurse practitioner scope of practice
Gardner, Anne and Gardner, Glenn. (2005). A trial of nurse practitioner scope of practice. Journal of Advanced Nursing. 49(2), pp. 135 - 145. https://doi.org/10.1111/j.1365-2648.2004.03273.x
Best practice in stabilisation of oral endotracheal tubes: a systematic review
Gardner, Anne, Hughes, Dot, Cook, Robert, Henson, Rachael, Osborne, Sonya and Gardner, Glenn. (2005). Best practice in stabilisation of oral endotracheal tubes: a systematic review. Australian Critical Care. 18(4), pp. 158 - 165. https://doi.org/10.1016/S1036-7314(05)80029-3
Parenting a preterm infant: Experiences in a regional neonatal health services programme
Rowe, Jennifer, Gardner, Glenn and Gardner, Anne. (2005). Parenting a preterm infant: Experiences in a regional neonatal health services programme. Neonatal, Paediatric and Child Health Nursing. 8(1), pp. 17 - 23.