Analysis of costs and benefits of transparent, gauze, or no dressing for a tunnelled central venous catheter in Canadian stem cell transplant recipients

Abstract

Catheter-related bloodstream infection (CRBSI), an avoidable risk in cancer nursing, contributes to patient morbidity, and increases health care spending. The objectives of the study were to evaluate the impact of three different nursing care strategies for tunnelled central venous catheter (CVC) exit sites on infection outcomes and compare costs of each strategy. The study hypothesis proposed that CRBSI and charges for nursing care differ in adult Canadian blood and marrow cell transplant recipients with a tunnelled CVC that use a transparent dressing, no dressing, or a gauze dressing. A sample of 432 records at a single centre compared CRBSI across dressing groups. A micro-costing approach was used to estimate dressing supply charges for an evaluation of the costs and benefits of each exit care strategy. Results of the study indicated no significant differences in CRBSI, number of organisms, gram stain of organisms, or days until the onset of an infection between the three dressing groups. The gauze dressing was considerably more expensive than both the transparent dressing and the no dressing strategy. In terms of supplies and nursing labour fees, transparent dressings were most economical, closely followed by no dressing. The no-dressing strategy was arguably the best option overall, as removing the dressing presents several other non-monetary and monetary benefits too broad for measurement by this study.