Analyse des coûts et avantages des pansements transparents, des pansements de gaze et de l’option sans pansement en présence d’un CVC tunnellisé chez les receveurs de greffe de cellules souches au Canada
Abstract
La bactériémie associée aux cathéters veineux centraux (BACC), un risque évitable en soins infirmiers en oncologie, est une cause de morbidité chez les patients et accroît les dépenses en soins de santé. Les objectifs de l’étude étaient d’évaluer l’incidence de trois stratégies infirmières différentes pour le site de sortie du cathéter veineux central (CVC) sur les résultats en matière d’infection et de comparer les coûts associés à chaque stratégie. Selon l’hypothèse de l’étude, les taux de BACC et les coûts afférents aux soins infirmiers diffèrent chez les adultes du Canada qui reçoivent des greffes de cellules souches par le biais d’un CVC tunnellisé en association avec un pansement transparent ou un pansement de gaze ou encore l’option sans pansement. Un échantillon de 432 dossiers d’un seul centre a permis de comparer les taux de BACC entre ces groupes de pansement. Le calcul des coûts sur une base individuelle a été utilisé pour estimer les frais de fourniture des pansements en vue d’évaluer les coûts et avantages de chacune des stratégies de prise en charge du site de sortie. Les résultats de l’étude révélaient qu’il n’existait pas de différences significatives, entre les trois stratégies de pansement, sur le plan des BACC, du nombre d’organismes, des résultats de la coloration de Gram ou du nombre de jours précédant l’apparition d’une infection. Le pansement de gaze revenait à bien plus cher que le pansement transparent et que l’option sans pansement. En ce qui concerne les frais de fournitures et de main-d’œuvre infirmière, les pansements transparents étaient les plus économiques, suivis de près par la stratégie sans pansement. La stratégie sans pansement était, semble-t-il, la meilleure option globale puisque le retrait des pansements présente plusieurs autres avantages monétaires et non monétaires mais de trop grande envergure pour pouvoir être mesurés dans le cadre de la présente étude.
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