Blue Ribbon Abstract Award: Increased central venous catheter–associated bloodstream infection rates temporally associated with changing from a split-septum to a Leur-access mechanical valve needleless device: A nationwide outbreak?

Abstract

ISSUE: When split-septum needleless devices (SSs) were first introduced, several central venous catheter–associated bloodstream infection (BSI) outbreaks ensued, traced to inadequate infection control practices. Since the introduction of Leur-access mechanical valve needleless devices (MVs), there have been increasing reports of increased CVC BSI rates, after switching from SSs to MVs. MVs from multiple manufacturers have been involved, and increased BSI rates were reported from hospitals across the United States. PROJECT: To obtain a better understanding of the frequency of this problem and the potential factors associated with increased BSI rates, infection control professionals (ICPs) who had documented increased BSI rates associated with switching from SSs to MVs were invited to meetings in Phoenix (June 2004) and Washington, D.C., (October 2004) and asked to share their data. RESULTS: BSI rate (per 1000 CVC days) data were available from ICPs at five hospitals. Reasons for changing from SSs to MVs included: to reduce percutaneous needlestick injuries (NSIs), for infusion pump compatibility, or in response to concerns about SS availability in the future. Hospital Location SS Period BSI Rate MV Period BSI Rate A Hospital-wide-pediatrics 1/03-3/03 1.7 4/03-6/03 8.6 B Hospital-wide 10/03-12/03 1.5 2/04-4/04 5.1 C Hospital-wide 1/02-5/02 2.3 6/02-4/03 3.5 D Pediatric ICU 1/04-3/04 5.4 7/04-9/04 17.3 E All ICUs 7/00-6/03 5.7 7/03-6/04 8.6 In all the hospitals, there was no evidence of decreased NSI and the increase in BSIs in the MV period continued despite re-education of healthcare workers about CVC insertion/maintenance aseptic technique, introduction of chlorhexidine skin antiseptic or patch for the CVC skin site, and use of maximal barriers for CVC insertion. At three hospitals, BSI rates decreased to pre-MV period rates after discontinuing the MV and returning to SS use; at the other two hospitals where MVs are still used, BSI rates have not returned to SS baseline rates. LESSONS LEARNED: Five hospitals where MVs were introduced to replace SSs experienced subsequent increased BSI rates. MV-associated BSI rates did not return to preceding SS baseline BSI rates, despite implementation of multiple CDC Intravenous Guideline recommendations. Introduction of MVs were not associated with decreased NSI rates. Further studies are needed to determine whether the increased BSI rates associated with MVs are related to infection control practices or intrinsic device design characteristics.