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Increased Bloodstream Infection Rates in Surgical Patients Associated with Variation from Recommended Use and Care Following Implementation of a Needleless Device

  • Susan Temporado Cookson (a1), Melanie Ihrig (a1), Edward M. O'Mara (a2), Mark Denny (a3), Helen Volk (a3), Shailen N. Banerjee (a1), Alan I. Hartstein (a2) (a3) and William R. Jarvis (a1)...

Abstract

Objective:

To determine if an apparent increase in bloodstream infections (BSIs) in patients with central venous catheters (CVCs) was associated with the implementation of a needleless access device.

Design:

Retrospective cohort study using a derived CVC-days factor for estimating appropriate denominator data.

Setting:

A 350-bed urban, acute, tertiary-care hospital.

Methods:

BSI surveillance data were obtained, and high-risk areas for BSIs were determined. A random 5% sample of medical records was used to estimate CVC days, and a cohort study was conducted to compare BSI rates before and during needleless device use. A survey was conducted of nursing needleless-device practices.

Results:

The surgical intensive-care unit (SICU), the medical intensive-care unit, and the solid organ transplant unit (OTU) were identified as high-risk units. Using existing surveillance BSI data and the estimated CVC days, the catheter-related BSI rates in the high-risk surgical patients were significantly higher during the needleless-device period compared with the preneedleless-device period (SICU, 9.4 vs 5.0/1,000 CVC days; OTU, 13.6 vs 2.2/1,000 CVC days). A survey of the nurses revealed that 60% to 70% were maintaining the needleless devices correctly.

Conclusion:

We observed a significant increase in the BSI rate in two surgical units, SICU and OTU, associated with introduction of a needleless device. This increase occurred shortly after the needleless device was implemented and was associated with nurses' unfamiliarity with the device, and needless-device use and care practices different from the manufacturer's recommendations.

Copyright

Corresponding author

Hospital Infections Program, Centers for Disease Control and Prevention, Mailstop E69, 1600 Clifton Rd, Atlanta, GA 30333

References

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1. Benson, JS. FDA Safety Alert: Needlestick and other risks from hypodermic needles on secondary IV administration sets—piggyback and intermittent IV. Rockville, MD: Food and Drug Administration; 1992. Letter to all US physicians.
2. Danzig, LE, Short, LJ, Collins, K, Mahoney, M, Sepe, S, Bland, L, et al. Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy. JAAMA 1995;273:18621864.
3. Kellerman, S, Shay, DK, Howard, J, Goes, S, Feusner, J, Rosenberg, J, et al. Bloodstream infections in home infusion patients: the influence of race and needleless intravascular access devices. J Pediatr 1996;129:711717.
4. Do, A, Ray, B, Barnett, B, Pham, M, Ball, L, Hendricks, K, et al. Evaluation of the role of needleless devices in bloodstream infections in home infusion therapy. Presented at the 36th Interscience Conference on Antimicrobial Agents and Chemotherapy; 09 17, 1996; New Orleans, LA.
5. McDonald, LC, Banerjee, S, Jarvis, W. Central venous catheter-associated bloodstream infections in intensive-care unit patients associated with needleless access devices. Infect Control Hosp Epidemiol 1997;18:P24. Abstract 28.
6. Cookson, ST, Ihrig, M, O'Mara, EM, Hartstein, AI, Jarvis, WR. Use of an estimation method to derive an appropriate denominator to calculate central venous catheter-associated bloodstream infection rates. Infect Control Hosp Epidemiol 1998;19:000000.
7. Ihrig, M, Cookson, ST, Campbell, K, Hartstein, AI, Jarvis, WR. Evaluation of the acceptability of a needleless vascular access system by nurses. Am J infect Control 1997;25:434438.
8. Kleinbaum, DG, Kupper, LL, Morganstern, H. Epidemiologic Research: Principles and Quantitative Methods. New York, NY: Van Nostrand Reinhold; 1982.

Increased Bloodstream Infection Rates in Surgical Patients Associated with Variation from Recommended Use and Care Following Implementation of a Needleless Device

  • Susan Temporado Cookson (a1), Melanie Ihrig (a1), Edward M. O'Mara (a2), Mark Denny (a3), Helen Volk (a3), Shailen N. Banerjee (a1), Alan I. Hartstein (a2) (a3) and William R. Jarvis (a1)...

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