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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)
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1. W McLaughlin , A Shillington , S Rich . Survival in primary pulmonary hypertension: the impact of epoprostenol therapy. Circulation 2002;106:14771482.

, , , . ;:–.2. O Sitbon M Humbert H Nunes et al.Long-term intravenous epoprostenol infusion in primary pulmonary hypertension: prognostic factors and survival J Am Coll Cardiol 2002 40 780788

3. VF Tapson , M Gomberg-Maitland , W McLaughlin , 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. AJ Kallen , E Lederman , A Balaji , et al.Bloodstream infections in patients given treatment with intravenous prostanoids. Infect Control Hosp Epidemiol 2008;29:342349.

5. DC McGee , MK Gould . Current concepts: preventing complications of central venous catheterization. N Engl J Med 2003;348:11231133.

6. RJ Oudiz , A Widlitz , XJ Beckmann , et al.Micrococcus-associated central venous catheter infection in patients with pulmonary arterial hypertension. Chest 2004;126:9094.

, , , . ;:–.7. JR Edwards KD Peterson ML Andrus et al.National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007 Am J Infect Control 2007 35 290301

, , , . ;:–.11. S Akagi H Matsubara A Ogawa et al.Prevention of catheter-related infections using a closed hub system in patients with pulmonary arterial hypertension Circ J 2007 71 559564

13. CJ Crnich , DG Maki . 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. MB Salzman , LG Rubin . Relevance of the catheter hub as a portal for microorganisms causing catheter-related bloodstream infections. Nutrition 1997;13(Suppl 4):15S17S.

, , , . . ;:–.15. GS Martin DM Mannino S Eaton M Moss The epidemiology of sepsis in the United States from 1979 through 2000 N Engl J Med 2003 348 15461554

, , , ; Healthcare Infection Control Practices Advisory Committee. . ;:–.16. NP O'Grady M Alexander EP Dellinger et alGuidelines for the prevention of intravascular catheter-related infections Infect Control Hosp Epidemiol 2002 23 759769

, , , . ;:–.22. ME Rupp LA Sholtz DR Jourdan 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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