An increase in pediatric intensive care unit (PICU) catheter-related bloodstream infection (CR-BSI) rate temporally associated with change in intravenous (IV) port

Abstract

ISSUE: In April 2004, the PICU switched from one mechanical valve (MV) IV port to a positive-displacement mechanical valve (PDMV) IV port. Associated with the switch, the NNIS defined CR-BSI rate increased fourfold. PROJECT: In February 2004, as part of a hospital-wide patient safety effort, the PICU instituted several measures to decrease the number of CR-BSIs: including implementation of a line cart to store supplies, preparation of skin with chlorhexidine, use of maximal barrier precautions, appropriate site selection, and use of an insertion checklist. In spite of these measures, the CR-BSI rate continued to climb. Several meetings were held with the children's center leaders to discuss possible reasons for the increased BSI rate and to develop a plan to reduce it. RESULTS: The CR-BSI rate increased from 4.1/1000 catheter days in the 1st quarter to 17.31/1000 catheter days in the 3rd quarter. Infections occurred from day 5 through day 157 post admission and involved both medical and surgical patients. No change in the case mix and acuity of patients admitted to the PICU was noted on investigation. Infections were caused by gram-positive and gram-negative organisms and Candida. Observations of central line insertions were made, and no infection control violations were noted. However, the PICU nurses reported that some of the PDMV leaked and were cracked. Because of the temporal association between introducing the PDMV and the increase in the CR-BSI rate, all PDMV were replaced with the MV that was previously used after re-education on the use of the antecedent valve. Since removing the PDMV in the 4th quarter, no further CR-BSIs have occurred. LESSONS LEARNED: Further studies need to be performed to define whether the PDMV is associated with an increase in CR-BSIs and to determine how the PDMV could contribute to an increase in CR-BSIs. Although "new and improved" products continue to flood the healthcare market, it is essential that appropriate trials be performed to demonstrate both efficacy and safety.