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Increased Rate of Catheter-Related Bloodstream Infection Associated With Use of a Needleless Mechanical Valve Device at a Long-Term Acute Care Hospital

Published online by Cambridge University Press:  02 January 2015

Cassandra D. Salgado ,
Libby Chinnes ,
Tammy H. Paczesny  and
J. Robert Cantey
Cassandra D. Salgado*
Affiliation:
Division of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina
Libby Chinnes
Affiliation:
Kindred Hospital, Charleston, South Carolina
Tammy H. Paczesny
Affiliation:
Kindred Hospital, Charleston, South Carolina
J. Robert Cantey
Affiliation:
Division of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina
*
Assistant Professor of Medicine, Division of Infectious Diseases, Medical University of South Carolina, 100 Doughty Street, Suite 210 IOP S, Charleston, SC 29425 ([email protected])
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Abstract

Objective.

To determine whether introduction of a needleless mechanical valve device (NMVD) at a long-term acute care hospital was associated with an increased frequency of catheter-related bloodstream infection (BSI).

Design.

For patients with a central venous catheter in place, the catheter-related BSI rate during the 24-month period before introduction of the NMVD, a period in which a needleless split-septum device (NSSD) was being used (hereafter, the NSSD period), was compared with the catheter-related BSI rate during the 24-month period after introduction of the NMVD (hereafter, the NMVD period). The microbiological characteristics of catheter-related BSIs during each period were also compared. Comparisons and calculations of relative risks (RRs) with 95% confidence intervals (CIs) were performed using χ2 analysis.

Results.

Eighty-six catheter-related BSIs (3.86 infections per 1,000 catheter-days) occurred during the study period. The rate of catheter-related BSI during the NMVD period was significantly higher than that during the NSSD period (5.95 vs 1.79 infections per 1,000 catheter-days; RR, 3.32 [95% CI, 2.88–3.83]; P < .001). A significantly greater percentage of catheter-related BSIs during the NMVD period were caused by gram-negative organisms, compared with the percentage recorded during the NSSD period (39.5% vs 8%; P = .007). Among catheter-related BSIs due to gram-positive organisms, the percentage caused by enterococci was significantly greater during the NMVD period, compared with the NSSD period (54.8% vs 13.6%; P = .004). The catheter-related BSI rate remained high during the NMVD period despite several educational sessions regarding proper use of the NMVD.

Conclusions.

An increased catheter-related BSI rate was temporally associated with use of a NMVD at the study hospital, despite several educational sessions regarding proper NMVD use. The current design of the NMVD may be unsafe for use in certain patient populations.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 6 , June 2007 , pp. 684 - 688
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.Panlilio, AL, Cardo, DM, Campbell, S, et al.Estimate of the annual number of percutaneous injuries in U.S. healthcare workers. In: Program and abstracts of the 4th International Conference on Nosocomial and Healthcare-Associated Infections; March 5-9, 2000; Atlanta. Abstract S-T2-01.Google Scholar
2.Roy, E, Robillard, P. Underreporting of blood and body fluid exposures in health care settings: an alarming issue. In: Proceedings of the International Social Security Association Conference on Bloodborne Infections: Occupational Risks and Prevention, Paris, France. June 8-9, 1995. 1995:341.Google Scholar
3.Centers for Disease Control and Prevention. Evaluation of safety devices for preventing percutaneous injuries among healthcare workers during phlebotomy procedures—Minneapolis-St. Paul, New York City, and San Francisco, 1993-1995. MMWR Morb Mortal Wkly Rep 1997;46:21–25.Google Scholar
4.Osborn, EHS, Papadakis, MA, Gerberding, JL. Occupational exposures to body fluids among medical students: a seven-year longitudinal study. Ann Intern Med 1999;130:45–51.Google Scholar
5.Abdel Malak, S, Eagan, J, Sepkowitz, KA. Epidemiology and reporting of needle-stick injuries at a tertiary cancer center. In: Program and abstracts of the 4th International Conference on Nosocomial and Healthcare-Associated Infections; March 5-9, 2000; Atlanta. Abstract P-S2-53.Google Scholar
6.United States General Accounting Office (GAO). Occupational Safety: Selected Cost and Benefit Implications of Needlestick Prevention Devices for Hospitals. Washington, DC: GAO; 2000. Publication GAO-01-60R.Google Scholar
7.Centers for Disease Control and Prevention. Workbook for designing, implementing, and evaluating a sharps injury prevention program. Available at: http://www.cdc.gov/sharpssafety/index.html. Accessed September 2006.Google Scholar
8.Jagger, J, Hunt, EH, Brand-Elnaggar, J, Pearson, R. Rates of needlestick injury caused by various devices in a university hospital. N Engl J Med 1988;319:284–288.Google Scholar
9.Pugliese, G, Bartley, J, McCormick, R. Selecting sharps injury prevention products. In: Cooper, E, ed. Medical Device Manufacturing and Technology. London: World Markets Research Centre, 2000:57–64.Google Scholar
10.Gartner, K. Impact of a needleless intravenous system in a university hospital. Am J Infect Control 1992;20:75–79.CrossRefGoogle ScholarPubMed
11.Skolnick, R, LaRocca, J, Barba, D, Paicius, L. Evaluation and implementation of a needleless intravenous system: making needlesticks a needless problem. Am J Infect Control 1993;21:39–41.Google Scholar
12.Yassi, A, McGill, ML, Khokhar, JB. Efficacy and cost-effectiveness of a needleless intravenous system. Am J Infect Control 1995;23:57–64.Google Scholar
13.Mendelson, MH, Short, LJ, Schechter, CB, et al.Study of a needleless intermittent intravenous-access system for peripheral infusions: analysis of staff, patient, and institutional outcomes. Infect Control Hosp Epidemiol 1998;19:401–406.CrossRefGoogle ScholarPubMed
14.Danzig, J, Short, II, Collins, K, et al.Bloodstream infections associated with a needleless intravenous infusions system in patients receiving home infusion therapy. JAMA 1995;273:1862–1864.CrossRefGoogle ScholarPubMed
15.Kellerman, S, Shay, DK, Howard, J, et al.Bloodstream infections in home infusion patients: the influence of race and needleless intravascular access devices. J Pediatr 1996;129:711–717.Google Scholar
16.Cookson, ST, Ihrig, M, O'Mara, EM, et al.Increased bloodstream infection rates in surgical patients associated with variation from recommended use and care following implementation of a needleless device. Infect Control Hosp Epidemiol 1998;19:23–27.CrossRefGoogle ScholarPubMed
17.Hall, KK, Geffers, C, Giannetta, E, Farr, BM. Outbreak of bloodstream infections temporally associated with a new needleless IV infusion system. In: Program and abstracts of the 14th Annual Scientific Meeting of the Society for Healthcare Epidemiologists of America; April 17-20, 2004; Philadelphia. Abstract 285.Google Scholar
18.Maragakis, LL, Bradley, KL, Song, X, et al.Increased catheter-related bloodstream infection rates after the introduction of a new mechanical valve intravenous access port. Infect Control Hosp Epidemiol 2006;27:67–70.Google Scholar
19.Karchmer, TB, Cook, EM, Palavecino, E, Ohl, CA, Sherertz, RJ. Needleless valve ports may be associated with a high rate of catheter-related bloodstream infections. In: Program and abstracts of the 15th Annual Scientific Meeting of the Society for Healthcare Epidemiologists of America; April 9-12, 2005; Los Angeles. Abstract 307.Google Scholar
20.Rupp, ME, Sholtz, LA, Jourdan, DR, et al. Outbreak of catheter-related bloodstream infections temporally associated with a positive displacement needleless valve. In: Program and abstracts of the 16th Annual Scientific Meeting of the Society for Healthcare Epidemiologists of America; March 18-21, 2006; Chicago. Abstract 227.Google Scholar
21.Maki, D, Mermel, L. Infections due to infusion therapy. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 4th ed. Philadelphia: LippincottRaven; 1998:689–724.Google Scholar
22.Crnick, CJ, Maki, DG. The promise of novel technology for the prevention of intravascular device-related bloodstream infection. I. Pathogenesis and short-term devices. Clin Infect Dis 2002;34:1232–1242.Google Scholar
23.Jarvis, WR. Needleless intravascular devices: when good devices go bad. In: Program and abstracts of the 16th Annual Scientific Meeting of the Society for Healthcare Epidemiologists of America; March 18-21, 2006; Chicago.Google Scholar
24.Menhay, SZ, Maki, DG. Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic barrier cap. Infect Control Hosp Epidemiol 2006;27:23–27.Google Scholar