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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

  • D. Dunbar Ivy (a1) (a2), Michelle Calderbank (a1) (a2), Brandie D. Wagner (a3), Susan Dolan (a4), Ann-Christine Nyquist (a5) (a4), Michael Wade (a6), William M. Nickels (a7) and Aimee K. Doran (a1) (a2)...
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.

Copyright
Corresponding author
Pediatric Pulmonary Hypertension Program, University of Colorado Denver, The Children's Hospital, 13123 E. 16th Ave., B100, Aurora, CO 80045 (ivy.dunbar@tchden.org)
References
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1.McLaughlin W, Shillington A, Rich S. Survival in primary pulmonary hypertension: the impact of epoprostenol therapy. Circulation 2002;106:14771482.
2.Sitbon O, Humbert M, Nunes H, et al.Long-term intravenous epoprostenol infusion in primary pulmonary hypertension: prognostic factors and survival. J Am Coll Cardiol 2002;40:780788.
3.Tapson VF, Gomberg-Maitland M, McLaughlin W, et al.Safety and efficacy of IV treprostinil for pulmonary arterial hypertension: a prospective, multicenter, open-label, 12-week trial. Chest 2006;129:683688.
4.Kallen AJ, Lederman E, Balaji A, et al.Bloodstream infections in patients given treatment with intravenous prostanoids. Infect Control Hosp Epidemiol 2008;29:342349.
5.McGee DC, Gould MK. Current concepts: preventing complications of central venous catheterization. N Engl J Med 2003;348:11231133.
6.Oudiz RJ, Widlitz A, Beckmann XJ, et al.Micrococcus-associated central venous catheter infection in patients with pulmonary arterial hypertension. Chest 2004;126:9094.
7.Edwards JR, Peterson KD, Andrus ML, et al.National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2007;35:290301.
8.Decker MD, Edwards KM. Central venous catheter infections. Pediatr Clin North Am 1988;35:579612.
9.Mpureau N, Poole S, Murdock MA, Gray SM, Semba CP. Central venous catheters in home infusion care: outcomes analysis in 50,470 patients. J Vase Interv Radiol 2002;13:10091016.
10.van Hoff J, Berg AT, Seashore JH. The effect of right atrial catheters on infectious complications of chemotherapy in children. J Clin Oncol 1990;8:12551262.
11.Akagi S, Matsubara H, Ogawa A, et al.Prevention of catheter-related infections using a closed hub system in patients with pulmonary arterial hypertension. Circ J 2007;71:559564.
12.Centers for Disease Control and Prevention. Bloodstream infections among patients treated with intravenous epoprostenol or intravenous treprostinil for pulmonary arterial hypertension—seven sites, United States, 2003-2006. MMWR Morb Mortal Wkly Rep 2007;56:170172.
13.Crnich CJ, Maki DG. The promise of novel technology for the prevention of intravascular device-related bloodstream infection. II. Long-term devices. Clin Infect Dis 2002;34:13621368.
14.Salzman MB, Rubin LG. Relevance of the catheter hub as a portal for microorganisms causing catheter-related bloodstream infections. Nutrition 1997;13(Suppl 4):15S17S.
15.Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348:15461554.
16.O'Grady NP, Alexander M, Dellinger EP, et al; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2002;23:759769.
17. Remodulin (treprostinil sodium) injection [package insert]. Research Triangle Park, NC: United Therapeutics Corp; 2008.
18. Flolan (epoprostenol sodium) for injection [package insert]. Research Triangle Park, NC: GlaxoSmifhKline; 2008.
19. Technical Test Protocol: TTP-LLR-MO305 (Zaccardelli, Cardinal Labs); data on file, United Therapeutics Corporation, Silver Spring, MD; 2007.
20.Phares K, Weiser WE, Miller SP, Myers MA, Wade M. Stability and preservative effectiveness of treprostinil sodium after dilution in common intravenous diluents. Am J Health Syst Pharm 2003;60:916922.
21.Doran AK, Ivy DD, Barst RJ, Hill N, Murali S, Benza RL; the Scientific Leadership Council of the Pulmonary Hypertension Association. Guidelines for the prevention of central venous catheter-related bloodstream infections with prostanoid therapy for pulmonary arterial hypertension. Int J Clin Pract Suppl 2008;160:59.
22.Rupp ME, Sholtz LA, Jourdan DR, et al.Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve. Clin Infect Dis 2007;44:14081414.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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