Increased rate of catheter-related bloodstream infection associated with use of a needleless mechanical valve device at a long-term acute care hospital

Infect Control Hosp Epidemiol. 2007 Jun;28(6):684-8. doi: 10.1086/516800. Epub 2007 May 14.

Abstract

Objective: To determine whether introduction of a needleless mechanical valve device (NMVD) at a long-term acute care hospital was associated with an increased frequency of catheter-related bloodstream infection (BSI).

Design: For patients with a central venous catheter in place, the catheter-related BSI rate during the 24-month period before introduction of the NMVD, a period in which a needleless split-septum device (NSSD) was being used (hereafter, the NSSD period), was compared with the catheter-related BSI rate during the 24-month period after introduction of the NMVD (hereafter, the NMVD period). The microbiological characteristics of catheter-related BSIs during each period were also compared. Comparisons and calculations of relative risks (RRs) with 95% confidence intervals (CIs) were performed using chi (2) analysis.

Results: Eighty-six catheter-related BSIs (3.86 infections per 1,000 catheter-days) occurred during the study period. The rate of catheter-related BSI during the NMVD period was significantly higher than that during the NSSD period (5.95 vs 1.79 infections per 1,000 catheter-days; RR, 3.32 [95% CI, 2.88-3.83]; P<.001). A significantly greater percentage of catheter-related BSIs during the NMVD period were caused by gram-negative organisms, compared with the percentage recorded during the NSSD period (39.5% vs 8%; P=.007). Among catheter-related BSIs due to gram-positive organisms, the percentage caused by enterococci was significantly greater during the NMVD period, compared with the NSSD period (54.8% vs 13.6%; P=.004). The catheter-related BSI rate remained high during the NMVD period despite several educational sessions regarding proper use of the NMVD.

Conclusions: An increased catheter-related BSI rate was temporally associated with use of a NMVD at the study hospital, despite several educational sessions regarding proper NMVD use. The current design of the NMVD may be unsafe for use in certain patient populations.

Publication types

  • Comparative Study

MeSH terms

  • Bacteremia / epidemiology*
  • Bacteremia / etiology
  • Bacteremia / microbiology
  • Catheterization, Central Venous / adverse effects*
  • Catheterization, Central Venous / instrumentation*
  • Catheterization, Central Venous / nursing
  • Catheters, Indwelling / microbiology*
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • Cross Infection / prevention & control
  • Disease Outbreaks / prevention & control
  • Education, Nursing, Continuing
  • Gram-Negative Bacteria / isolation & purification*
  • Gram-Negative Bacterial Infections / epidemiology*
  • Gram-Negative Bacterial Infections / microbiology
  • Gram-Negative Bacterial Infections / prevention & control
  • Hospitals, Special / standards*
  • Hospitals, Special / statistics & numerical data
  • Humans
  • Long-Term Care / standards*
  • Needlestick Injuries / prevention & control
  • Nursing Staff, Hospital / education*
  • Nursing Staff, Hospital / standards
  • Sentinel Surveillance
  • South Carolina / epidemiology