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

Infect Control Hosp Epidemiol. 2009 Sep;30(9):823-9. doi: 10.1086/605320.


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.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Antihypertensive Agents / administration & dosage*
  • Bacteremia / epidemiology*
  • Bacteremia / microbiology
  • Bacteremia / transmission
  • Catheterization, Central Venous / adverse effects*
  • Catheterization, Central Venous / instrumentation*
  • Catheterization, Central Venous / methods
  • Catheters, Indwelling / microbiology
  • Epoprostenol / administration & dosage*
  • Epoprostenol / analogs & derivatives*
  • Equipment Contamination
  • Gram-Negative Bacteria / isolation & purification
  • Gram-Negative Bacterial Infections / epidemiology
  • Gram-Negative Bacterial Infections / transmission
  • Gram-Positive Bacteria / isolation & purification
  • Gram-Positive Bacterial Infections / epidemiology
  • Gram-Positive Bacterial Infections / transmission
  • Humans
  • Hypertension, Pulmonary / drug therapy*
  • Incidence
  • Infusions, Intravenous / adverse effects
  • Risk Reduction Behavior


  • Antihypertensive Agents
  • Epoprostenol
  • treprostinil