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Line-Associated Bloodstream Infections in Pediatric Intensive-Care–Unit Patients Associated With a Needleless Device and Intermittent Intravenous Therapy

Published online by Cambridge University Press:  02 January 2015

L. Clifford McDonald ,
Shailen N. Banerjee  and
William R. Jarvis
L. Clifford McDonald
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Shailen N. Banerjee
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
William R. Jarvis*
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Hospital Infections Program, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E69, Atlanta, GA 30333; e-mail wrj1@cdc.gov
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Abstract

Objectives:

To determine risk factors for an increase in line-associated bloodstream infections (BSIs) in three pediatric intensive-care units at one hospital that recently had changed brands of needleless access device.

Design:

Retrospective case-control studies; review of the units' infection control policies and procedures for accessing and replacing components of needleless access devices.

Setting:

A community tertiary-care hospital's three pediatric intensive-care units.

Patients:

Children in one of the three intensive-care units with a central venous catheter in place during January 1, 1995, through May 15, 1996, who developed laboratory-confirmed primary BSI. Children who had central venous catheters in place for >48 hours and who did not develop BSI were chosen randomly as controls.

Results:

Eight patients met the case definition; they had 11 episodes of BSI. Multivariate analysis identified duration of catheterization and exposure to the IVAC first-generation needleless device as independent risk factors for BSI. Compared with patients from another pediatric intensive-care unit in which the IVAC device also was used but in which an increased BSI rate did not occur, patients from the unit with an increased BSI rate were more likely to receive intermittent (vs continuous) intravenous therapy through one or more lumens. In both units, the IVAC device valve component was replaced every 6 days, and the endcap used to cover the valve (when connected to an unused lumen) was replaced every 24 hours or after each access. The BSI rate returned to baseline after institution of a policy to replace the entire IVAC device, valve, and endcap every 24 hours.

Conclusions:

An increased risk of BSI was associated with use of the IVAC first-generation needleless device when replaced every 6 days. This increased risk may have been more pronounced in one pediatric intensive-care unit, because patients were more likely to receive intermittent intravenous therapy. Intermittent intravenous therapy or central venous catheter flushing practices may be important determinants of BSI risk

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 10 , October 1998 , pp. 772 - 777
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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