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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

Cassandra D. Salgado , MD, MS, Libby Chinnes , RN, BSN, CIC, Tammy H. Paczesny , RN and J. Robert Cantey , MD
Infection Control and Hospital Epidemiology
Vol. 28, No. 6 (June 2007), pp. 684-688
DOI: 10.1086/516800
Stable URL: http://www.jstor.org/stable/10.1086/516800
Page Count: 5
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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
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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]; \documentclass{aastex} \usepackage{amsbsy} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{bm} \usepackage{mathrsfs} \usepackage{pifont} \usepackage{stmaryrd} \usepackage{textcomp} \usepackage{portland,xspace} \usepackage{amsmath,amsxtra} \usepackage[OT2,OT1]{fontenc} \newcommand\cyr{ \renewcommand\rmdefault{wncyr} \renewcommand\sfdefault{wncyss} \renewcommand\encodingdefault{OT2} \normalfont \selectfont} \DeclareTextFontCommand{\textcyr}{\cyr} \pagestyle{empty} \DeclareMathSizes{10}{9}{7}{6} \begin{document} \landscape $P< .001$ \end{document} ). 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%; \documentclass{aastex} \usepackage{amsbsy} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{bm} \usepackage{mathrsfs} \usepackage{pifont} \usepackage{stmaryrd} \usepackage{textcomp} \usepackage{portland,xspace} \usepackage{amsmath,amsxtra} \usepackage[OT2,OT1]{fontenc} \newcommand\cyr{ \renewcommand\rmdefault{wncyr} \renewcommand\sfdefault{wncyss} \renewcommand\encodingdefault{OT2} \normalfont \selectfont} \DeclareTextFontCommand{\textcyr}{\cyr} \pagestyle{empty} \DeclareMathSizes{10}{9}{7}{6} \begin{document} \landscape $P=.007$ \end{document} ). 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%; \documentclass{aastex} \usepackage{amsbsy} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{bm} \usepackage{mathrsfs} \usepackage{pifont} \usepackage{stmaryrd} \usepackage{textcomp} \usepackage{portland,xspace} \usepackage{amsmath,amsxtra} \usepackage[OT2,OT1]{fontenc} \newcommand\cyr{ \renewcommand\rmdefault{wncyr} \renewcommand\sfdefault{wncyss} \renewcommand\encodingdefault{OT2} \normalfont \selectfont} \DeclareTextFontCommand{\textcyr}{\cyr} \pagestyle{empty} \DeclareMathSizes{10}{9}{7}{6} \begin{document} \landscape $P=.004$ \end{document} ). 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.

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