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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

Published online by Cambridge University Press:  02 January 2015

Susan Temporado Cookson ,
Melanie Ihrig ,
Edward M. O'Mara ,
Mark Denny ,
Helen Volk ,
Shailen N. Banerjee ,
Alan I. Hartstein  and
William R. Jarvis
Susan Temporado Cookson
Affiliation:
Hospital Infections Program, Indiana University Medical Center, Indianapolis, Indiana
Melanie Ihrig
Affiliation:
Hospital Infections Program, Indiana University Medical Center, Indianapolis, Indiana
Edward M. O'Mara
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia, the Division of Infectious Diseases, Indiana University Medical Center, Indianapolis, Indiana
Mark Denny
Affiliation:
Department of Medicine, Indianapolis, Indiana; the Department of Infection Control/Epidemiology, Indiana University Medical Center, Indianapolis, Indiana
Helen Volk
Affiliation:
Department of Medicine, Indianapolis, Indiana; the Department of Infection Control/Epidemiology, Indiana University Medical Center, Indianapolis, Indiana
Shailen N. Banerjee
Affiliation:
Hospital Infections Program, Indiana University Medical Center, Indianapolis, Indiana
Alan I. Hartstein
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia, the Division of Infectious Diseases, Indiana University Medical Center, Indianapolis, Indiana Department of Medicine, Indianapolis, Indiana; the Department of Infection Control/Epidemiology, Indiana University Medical Center, Indianapolis, Indiana
William R. Jarvis*
Affiliation:
Hospital Infections Program, Indiana University Medical Center, Indianapolis, Indiana
*
Hospital Infections Program, Centers for Disease Control and Prevention, Mailstop E69, 1600 Clifton Rd, Atlanta, GA 30333
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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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 1 , January 1998 , pp. 23 - 27
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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