Catheter-Related Infection Rate in Patients in Home Parenteral Nutrition

Abstract

Introduction: Home parenteral nutrition (HPN) is commonly indicated in patients with intestinal failure (IF) and may be a lifesaving therapy[1][2]. Since 1991, the multidisciplinary short-bowel syndrome clinic (AMULSIC) of the Clinics Hospital of the University of São Paulo Medical School (HC-FMUSP) has been following patients with IF offering HPN at no cost to the patient. Long-term central venous access is necessary for HPN and catheter-related infections are within its main complications. The care for the prevention of infections is paramount for patient survival[1][3]. Objective: To analyze the catheter-related infection rate in patients in HPN from 2014 to 2016. Methods: Retrospective study using patients' charts and household follow-up records. Catheter-related blood infection rate is expressed as the number of episodes of infections per 1,000 catheter days. It was used to define the infection rate in HPN patients from January 2014 to December 2016 (4,5). All patients underwent a previous evaluation under cognitive, educational, social and family conditions to begin in the program and received training by a nurse experienced in this care, including issues related to cleaning of the environment and materials, hand hygiene, central catheter care, administration of medications and recognition of complications. These patients remain at home performing catheter self-care or being assisted by trained family members. They return to our clinic in a weekly basis for follow-up and withdrawal of medications and materials. Results: A total of 14 patients were studied, of which 42.9% are female and 57.1% are male. 57.1% of patients used heparinized Hickman's catheter and 42.9% used PICC with catheter salinization orientation. The mean number of catheter infections during the three years was 1.11 for every 1000 catheters/day. In total, the patients had nine catheter infections during this period and four of them occurred with only one patient who did not have good adherence to the program and did not follow the guidelines given even after several meetings with the team. Conclusions: The result found in our research is consistent with that found in the literature where the average catheter-related bloodstream infection is at 1.31/1000 days of catheter, ranging from 0.38 and 4.58/1000 days of catheter[4]. HPN survival is directly related to the number of catheter infections, so patient education is a crucial intervention to ensure good outcomes.