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Closed‐Hub Systems with Protected Connections and the Reduction of Risk of Catheter‐Related Bloodstream Infection in Pediatric Patients Receiving Intravenous Prostanoid Therapy for Pulmonary Hypertension

D. Dunbar Ivy , MD, Michelle Calderbank , RN, BSN, Brandie D. Wagner , PhD, Susan Dolan , RN, MS, CIC, Ann‐Christine Nyquist , MD, MSPH, Michael Wade , PhD, William M. Nickels and Aimee K. Doran , MS, RN, CPNP
Infection Control and Hospital Epidemiology
Vol. 30, No. 9 (September 2009), pp. 823-829
DOI: 10.1086/605320
Stable URL: http://www.jstor.org/stable/10.1086/605320
Page Count: 7
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Closed‐Hub Systems with Protected Connections and the Reduction of Risk of Catheter‐Related Bloodstream Infection in Pediatric Patients Receiving Intravenous Prostanoid Therapy for Pulmonary Hypertension
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Abstract

Background.  Intravenous prostanoids (epoprostenol and treprostinil) are effective therapies for pulmonary arterial hypertension but carry a risk of catheter‐related bloodstream infection (CR‐BSI). Prevention of CR‐BSI during long‐term use of indwelling central venous catheters is important. Objective.  To evaluate whether using a closed‐hub system and waterproofing catheter hub connections reduces the rate of CR‐BSI per 1,000 catheter‐days. Design.  Single‐center open observational study (January 2003–December 2008). Patients.  Pediatric patients with pulmonary arterial hypertension who received intravenous prostanoids. Methods.  In July 2007, CR‐BSI preventive measures were implemented, including the use of a closed‐hub system and the waterproofing of catheter hub connections during showering. Rates of CR‐BSI before and after implementing preventive measures were compared with respect to medication administered and type of bacterial infection. Results.  Fifty patients received intravenous prostanoid therapy for a total of 41,840 catheter‐days. The rate of CR‐BSI during the study period was 0.51 infections per 1,000 catheter‐days for epoprostenol and 1.38 infections per 1,000 catheter‐days for treprostinil, which differed significantly ( \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 $P< .01$ \end{document} ). CR‐BSIs caused by gram‐negative pathogens occurred more frequently with treprostinil than with epoprostenol (0.91 infections per 1,000 catheter‐days vs 0.08 infections per 1,000 catheter‐days; \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 $P< .01$ \end{document} ). Patients treated with treprostinil after the implemented changes had a significant decrease in CR‐BSI rate (1.95 infections per 1,000 catheter‐days vs 0.19 infections per 1,000 catheter‐days; \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 $P< .01$ \end{document} ). Conclusion.  The closed‐hub system and the maintenance of dry catheter hub connections significantly reduced the incidence of CR‐BSI (particularly infections caused by gram‐negative pathogens) in patients receiving intravenous treprostinil.

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