Modeling the Economic Value of the Distribution of Preoperative Chlorhexidine Bathing Kits for the Prevention of Surgical Site Infections

Background: To determine the potential economic value of home-based preoperative chlorhexidine cloth application for the prevention of surgical site infections (SSIs) in orthopedic surgery patients.

Objective: Evaluate the decision of whether to distribute preoperative chlorhexidine bathing kits to orthopedic surgery patients.

Methods: We developed a stochastic computer simulation model. Sensitivity analyses systematically evaluated the impact of cloth cost, cloth efficacy, hospital bed day cost, patient age, patient compliance, surgical site infection attributable excess length of stay on the overall economic value of distributing preoperative bathing kits.

Results: The largest drivers of the economic value of preoperative bathing kits were cloth efficacy and patient compliance. For baseline scenarios, when chlorhexidine cloth efficacy was ≥50%, distribution of bathing kits was the dominant strategy (i.e., less costly and more effective than no kit distribution) when patient compliance of 7.65% (half of the baseline value). Analyses evaluating decreased cloth efficacy (i.e., 10%) showed bathing as the dominant strategy given compliance ≥22.95% (1.5 times baseline).

Conclusions: Distribution of home-based preoperative chlorhexidine bathing kits for the prevention of surgical site infections is cost-effective across a wide range of cloth efficacy and patient compliance values. Further investigation of the cloth efficacy and patient compliance is warranted.