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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

Published online by Cambridge University Press:  02 January 2015

D. Dunbar Ivy ,
Michelle Calderbank ,
Brandie D. Wagner ,
Susan Dolan ,
Ann-Christine Nyquist ,
Michael Wade ,
William M. Nickels  and
Aimee K. Doran
D. Dunbar Ivy*
Affiliation:
Sections of Pediatric Cardiology, Colorado The Children's Hospital, Colorado
Michelle Calderbank
Affiliation:
Sections of Pediatric Cardiology, Colorado The Children's Hospital, Colorado
Brandie D. Wagner
Affiliation:
University of Colorado Denver School of Medicine, and the Department of Biostatistics and Informatics, Colorado School of Public Health, Colorado
Susan Dolan
Affiliation:
University of Colorado Denver, and the Department of Epidemiology, Colorado
Ann-Christine Nyquist
Affiliation:
Pediatric Infectious Disease, Colorado University of Colorado Denver, and the Department of Epidemiology, Colorado
Michael Wade
Affiliation:
United Therapeutics Corporation, Silver Spring, Maryland
William M. Nickels
Affiliation:
Aurora, and Aero Manufacturing Corporation, Englewood, Colorado
Aimee K. Doran
Affiliation:
Sections of Pediatric Cardiology, Colorado The Children's Hospital, Colorado
*
Pediatric Pulmonary Hypertension Program, University of Colorado Denver, The Children's Hospital, 13123 E. 16th Ave., B100, Aurora, CO 80045 (ivy.dunbar@tchden.org)
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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 (P < .01 ). 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; P <.01). 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; P <.01).

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 9 , September 2009 , pp. 823 - 829
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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