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Environmental Exposures and the Risk of Central Venous Catheter Complications and Readmissions in Home Infusion Therapy Patients

Published online by Cambridge University Press:  04 October 2016

Sara C. Keller ,
Deborah Williams ,
Mitra Gavgani ,
David Hirsch ,
John Adamovich ,
Dawn Hohl ,
Amanda Krosche ,
Sara Cosgrove  and
Trish M. Perl
Sara C. Keller*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Deborah Williams
Affiliation:
Johns Hopkins Home Care Group, Baltimore, Maryland.
Mitra Gavgani
Affiliation:
Johns Hopkins Home Care Group, Baltimore, Maryland.
David Hirsch
Affiliation:
Johns Hopkins Home Care Group, Baltimore, Maryland.
John Adamovich
Affiliation:
Johns Hopkins Home Care Group, Baltimore, Maryland.
Dawn Hohl
Affiliation:
Johns Hopkins Home Care Group, Baltimore, Maryland.
Amanda Krosche
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Sara Cosgrove
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Trish M. Perl
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Address correspondence to Sara C. Keller, MD, MPH, MSHP, 10751 Falls Road, Suite 412, Lutherville, MD 21093 (skeller9@jhmi.edu).
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Abstract

BACKGROUND

Patients are frequently discharged with central venous catheters (CVCs) for home infusion therapy.

OBJECTIVE

To study a prospective cohort of patients receiving home infusion therapy to identify environmental and other risk factors for complications.

DESIGN

Prospective cohort study between March and December 2015.

SETTING

Home infusion therapy after discharge from academic medical centers.

PARTICIPANTS

Of 368 eligible patients discharged from 2 academic hospitals to home with peripherally inserted central catheters and tunneled CVCs, 222 consented. Patients remained in the study until 30 days after CVC removal.

METHODS

Patients underwent chart abstraction and monthly telephone surveys while the CVC was in place, focusing on complications and environmental exposures. Multivariable analyses estimated adjusted odds ratios and adjusted incident rate ratios between clinical, demographic, and environmental risk factors and 30-day readmissions or CVC complications.

RESULTS

Of 222 patients, total parenteral nutrition was associated with increased 30-day readmissions (adjusted odds ratio, 4.80 [95% CI, 1.51–15.21) and CVC complications (adjusted odds ratio, 2.41 [95% CI, 1.09–5.33]). Exposure to soil through gardening or yard work was associated with a decreased likelihood of readmissions (adjusted odds ratio, 0.09 [95% CI, 0.01–0.74]). Other environmental exposures were not associated with CVC complications.

CONCLUSIONS

complications and readmissions were common and associated with the use of total parenteral nutrition. Common environmental exposures (well water, cooking with raw meat, or pets) did not increase the rate of CVC complications, whereas soil exposures were associated with decreased readmissions. Interventions to decrease home CVC complications should focus on total parenteral nutrition patients.

Infect Control Hosp Epidemiol 2016;1–8

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 1 , January 2017 , pp. 68 - 75
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: IDWeek 2015, San Diego, California, October 7–11, 2015, abstract 1454; the National Home Infusion Association Conference, New Orleans, Louisiana, March 21–24, 2016, abstract 2; the Translational Science Conference, Washington, DC, April 13–15 2016, abstract TMP123; and the Society of Healthcare Epidemiology of America Annual Conference, Atlanta, Georgia, May 18–21, 2016 abstract 7851.

S.C. and T.M.P. contributed equally to this article.

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