Intravenous literature: Ivy, D.D., Calderbank, M., Wagner, B.D., Dolan, S., Nyquist, C., Wade, M., Nickels, W.M. and Doran, A.K. (2009) Closedâ€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. Infection Control & Hospital Epidemiology. 30.
Background: Intravenous prostanoids (epoprostenol and treprostinil) are effective therapies for pulmonary arterial hypertension but carry a risk of catheterâ€related bloodstream infection (CRBSI). Prevention of CRBSI 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 CRBSI per 1,000 catheterâ€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, CRBSI preventive measures were implemented, including the use of a close-hub system and the waterproofing of catheter hub connections during showering. Rates of CRBSI 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 catheterâ€days. The rate of CRBSI 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 ( ). CRBSIs caused by gram-negative pathogens occurred more frequently with treprostinil than with epoprostenol (0.91 infections per 1,000 catheterâ€days vs 0.08 infections per 1,000 catheter-days; ). Patients treated with treprostinil after the implemented changes had a significant decrease in CRBSI rate (1.95 infections per 1,000 catheter-ays vs 0.19 infections per 1,000 catheterâ€days; ).
Conclusion: The closed-hub system and the maintenance of dry catheter hub connections significantly reduced the incidence of CRBSI (particularly infections caused by gram-negative pathogens) in patients receiving intravenous treprostinil.