Dramatic decrease of implanted central venous catheter-related infections by applying a simple but multicomponent prophylactic multidisciplinary program in a lung cancer clinic

Abstract

Introduction Subcutaneous implanted ports (SIP) are long-term devices often used in oncology practices because they have fewer infectious complications than others central venous catheters and because they preserve a better quality of life for patients, especially for sequential treatments. In literature, the incidence of infectious complications on SIP differed depending on patient's pathology, perfusions (parenteral nutrition), catheterization durations and other infectious events. Methods In order to meet the demand of lung specialist to decrease infections, an observational study was conducted to describe the infectious complication incidence and to identify the risk factors of catheter infections during two periods before and after a multimodal infection prevention program. All patients who had undergone SIP insertion, whatever the indication, during a stay in one of the three units of Pulmonology were included in the study. Two periods of surveillance were studied: (i) P1 of November 15 2012 to December 31, 2013; and (ii) P2 from September 1, 2014 to November 1, 2015. All patients were followed prospectively from the date of SIP insertion to the occurrence of the first infection, until the removal of SIP, until the death of the patient, or for a maximum of 6 months. The incidence of catheter infection is expressed as events per 1000 catheter days. Catheterization days were calculated from the start date of insertion to the end of the follow-up. During P1, parameters collected were demographic factors of patients, diabetes, patient dependence score, infectious disease history, indication and SIP placement, first or second SIP, immediate complications after catheter placement (hematoma), perfusions type (transfusion, chemotherapy, parenteral nutrition). During P2, the statistically significant factors of P1 were recorded. In univariate analysis Pearson's Chi2 test and the Z test were used. For multivariate analysis, a Cox model was used for the comparison of survival of CVC without an infection-related problem. Each factor related to infectious risk in univariate analysis and interactions was included in the model. Univariate and multivariate analyses were made using SPSS software. Results All patients have care both in hospital (in ambulatory care unit or hospitalized unit) and at home. During the first period, 61 SIP for 56 patients were included covering a total of 6,966 catheterization days. The incidence of infections was 2.87 per 1000 catheter days corresponding with 16 catheter-related bloodstream infections (CRBSIs) and 4 local SIP infections.17 SIP were removing because of infection. Staphylococcus epidermidis, Staphylococcus aureus and Enterobacter cloacae were the main microorganisms identified. Four early infections occurred within 7 days after inclusion. A multivariate analysis highlighted a significant effect of parenteral nutrition (OR = 4.94, P –hospital and home nurses formation with posters summarizing points main parts of infection catheter prevention and evaluation of knowledge on aseptic catheter protocols; –used of taurolidine lock prophylaxis for patient with parenteral nutrition; –observations and education of surgical staff on hand hygiene and aseptic technique. During the second period, 69 SIP for 60 patients were included covering a total of 9343 catheterization days. Incidence of infections was 0.71 per 1000 catheter days corresponding with 4 CRBSIs and 3 local SIP infections. No early infections were observed. A very important decrease of incidence of infections was observed between the two periods. Conclusion This result shows that the application of a prevention program with a multidisciplinary approach involving medical and chirurgical staff, nurses working in and out hospital to provide continuing education to all healthcare providers, is efficacy to decrease this infections.