Skip to main content Accessibility help
×
Home
Hostname: page-component-dc8c957cd-78gqf Total loading time: 0.231 Render date: 2022-01-27T00:44:17.628Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Catheter-Related Polymicrobial Bloodstream Infections among Pediatric Bone Marrow Transplant Outpatients—Atlanta, Georgia, 2007

Published online by Cambridge University Press:  02 January 2015

Petra Wiersma*
Affiliation:
Epidemic Intelligence Service, Atlanta, Georgia Georgia Department of Human Resources, Division of Public Health, Atlanta, Georgia
Sarah Schillie
Affiliation:
Epidemic Intelligence Service, Atlanta, Georgia
Harry Keyserling
Affiliation:
Centers for Disease Control and Prevention, the Emory University School of Medicine, Atlanta, Georgia
J. Renee Watson
Affiliation:
Children's Healthcare of Atlanta, Atlanta, Georgia
Anindya De
Affiliation:
Division of Healthcare Quality Promotion, Atlanta, Georgia
Shailendra N. Banerjee
Affiliation:
Division of Healthcare Quality Promotion, Atlanta, Georgia
Cherie L. Drenzek
Affiliation:
Georgia Department of Human Resources, Division of Public Health, Atlanta, Georgia
Kathryn E. Arnold
Affiliation:
Georgia Department of Human Resources, Division of Public Health, Atlanta, Georgia
Christina Shivers
Affiliation:
Epidemiology Elective Program, Atlanta, Georgia
Lea Kendrick
Affiliation:
Children's Healthcare of Atlanta, Atlanta, Georgia
Lydia Gonzalez Ryan
Affiliation:
Children's Healthcare of Atlanta, Atlanta, Georgia
Bette Jensen
Affiliation:
Division of Healthcare Quality Promotion, Atlanta, Georgia
Judith Noble-Wang
Affiliation:
Division of Healthcare Quality Promotion, Atlanta, Georgia
Arjun Srinivasan
Affiliation:
Division of Healthcare Quality Promotion, Atlanta, Georgia
*
5120 Geneva Place, Dulles, VA 20189, (petra.wiersma@gmail.com)

Abstract

Objective.

To identify risk factors for polymicrobial bloodstream infections (BSIs) in pediatric bone marrow transplant (BMT) outpatients attending a newly constructed clinic affiliated with a children's hospital.

Methods.

All 30 outpatients treated at a new BMT clinic during September 10-21, 2007, were enrolled in a cohort study. The investigation included interviews, medical records review, observations, and bacterial culture and molecular typing of patient and environmental isolates. Data were analyzed using exact conditional logistic regression.

Results.

Thirteen patients experienced BSIs caused by 16 different, predominantly gram-negative organisms. Presence of a tunneled catheter (odds ratio [OR], 19.9 [95% confidence interval {CI}, 2.4-∞), catheter access (OR, 13.7 [95% CI, 1.8-∞]), and flushing of a catheter with predrawn saline (OR, 12.9 [95% CI, 1.0-766.0]) were independently associated with BSI. The odds of experiencing a BSI increased by a factor of 16.8 with each additional injection of predrawn saline (95% CI, 1.8-827.0). Although no environmental source of pathogens was identified, interviews revealed breaches in recommended infection prevention practice and medication handling. Saline flush solutions were predrawn, and multiple doses were obtained from single-dose preservative-free vials to avoid delays in patient care.

Conclusion.

We speculate that infection prevention challenges in the new clinic, combined with successive needle punctures of vials, facilitated extrinsic contamination and transmission of healthcare-associated pathogens. We recommend that preservative-free single-use vials not be punctured more than once. Use of single-use prefilled saline syringes might prevent multiuse of single-use saline vials. Storage of saline outside a medication supply system might be advisable. Before opening new clinic facilities, hospitals should consider conducting a mock patient flow exercise to identify infection control challenges.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Wisplinghoff, H, Seifert, H, Wenzel, RP, Edmond, MB. Inflammatory response and clinical course of adult patients with nosocomial bloodstream infections caused by Candida spp. Clin Microbiol Infect 2006;12:170177.CrossRefGoogle ScholarPubMed
2.Wenzel, RP, Edmond, MB. The impact of hospital-acquired bloodstream infections. Emerg Infect Dis 2001;7:174177.CrossRefGoogle ScholarPubMed
3.Wenzel, RP. The mortality of hospital-acquired bloodstream infections: need for a new vital statistic? Int J Epidemiol 1988;17:225227.CrossRefGoogle Scholar
4. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR Recomm Rep 2002;51:126.Google ScholarPubMed
5.Smith, TL, Pullen, GT, Crouse, V, Rosenberg, J, Jarvis, WR. Bloodstream infections in pediatric oncology outpatients: a new healthcare systems challenge. Infect Control Hosp Epidemiol 2002;23:236238.CrossRefGoogle ScholarPubMed
6.Wenzel, RP, Edmond, MB. The evolving technology of venous access. N Engl J Med 1999;340:4849.CrossRefGoogle Scholar
7.Downes, KJ, Metlay, JP, Bell, LM, McGowan, KL, Elliott, MR, Shah, SS. Polymicrobial bloodstream infections among children and adolescents with central venous catheters evaluated in ambulatory care. Clin Infect Dis 2008;46:387394.CrossRefGoogle ScholarPubMed
8.Penzak, SR, Gubbins, PO, Stratton, SL, Anaissie, EJ. Investigation of an outbreak of gram-negative bacteremia among hematology-oncology outpatients. Infect Control Hosp Epidemiol 2000;21:597599.CrossRefGoogle ScholarPubMed
9.Urrea, M, Rives, S, Cruz, O, Navarro, A, Garcia, JJ, Estella, J. Nosocomial infections among pediatric hematology/oncology patients: results of a prospective incidence study. Am J Infect Control 2004;32:205208.CrossRefGoogle ScholarPubMed
10. Centers for Disease Control and Prevention. Acute hepatitis C virus infections attributed to unsafe injection practices at an endoscopy clinic—Nevada, 2007. MMWR Morb Mortal Wkly Rep 2008;57:513517.Google ScholarPubMed
11.Pan, A, Dolcetti, L, Barosi, C, et al.An outbreak of Serratia marcescens bloodstream infections associated with misuse of drug vials in a surgical ward. Infect Control Hosp Epidemiol 2006;27:7982.CrossRefGoogle Scholar
12.Grohskopf, LA, Roth, VR, Feikin, DR, et al.Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center. N Engl J Med 2001;344:14911497.CrossRefGoogle Scholar
13.Cheng, VC, Wai, KL, Woo, PCY, et al.Polymicrobial outbreak of intermittent peritoneal dialysis peritonitis during external wall renovation at a dialysis center. Perit Dial Int 2001;21:296301.Google Scholar
10
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Catheter-Related Polymicrobial Bloodstream Infections among Pediatric Bone Marrow Transplant Outpatients—Atlanta, Georgia, 2007
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Catheter-Related Polymicrobial Bloodstream Infections among Pediatric Bone Marrow Transplant Outpatients—Atlanta, Georgia, 2007
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Catheter-Related Polymicrobial Bloodstream Infections among Pediatric Bone Marrow Transplant Outpatients—Atlanta, Georgia, 2007
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *