Abstract
Topic Significance & Study Purpose/Background/Rationale Long term maintenance of Hickman catheter [HC] following allogeneic transplantation is a nursing challenge particularly in those colonized with Methicillin Resistant Staphylococcus Aureus [MRSA] or Coagulase Negative Staphylococcus [MRCoNS]. We prospectively analyzed the feasibility of long-term maintenance of HC after haploidentical family donor transplantation in 67 patients colonized with MRSA or MRCoNS employing Chlorhexidine impregnated patch [CIP,BIOPATCH 44150]. Methods, Intervention, & Analysis Patients undergoing haploidentical transplantation were screened for MRSA/MRCoNS with weekly nasal & skin swabs before transplantation & weekly thereafter for four weeks. Colonized patients were initiated on eradication protocol with Mupirocin ointment & Chlorhexidine bath. The patients were nursed in a class 1000 room with 1:1 nursing. HC dressing was carried out every 5 th day as inpatient & weekly thereafter with CIP and transparent dressing. Planned removal of HC was carried out at 180 days. HC which were retained beyond this period were taken care of by the caregivers who was intensively trained for the same. We analysed the incidence of catheter related bloodstream infections (CRBSI) or Hickman Catheter associated soft tissue Infections [HCASTI] following transplantation until the removal of HC. Findings & Interpretation 67 patients [males: 43, females: 24; malignant ds: 50, non-malignant ds: 17] who were colonized with MRSA [N=42] & MRCoNS [N=25] underwent PTCy based Haploidentical transplantation. The median age of the cohort was 32 years (range 2-65); 26 of those were Discussion & Implications Our study shows that with meticulous nursing coupled with intensive education of the patients & caregivers, long term maintenance of HC is possible without CRBSI or HCASTI. Employment of rigorous eradication program and application of Chlorhexidine based approach in HC dressing helped in minimizing the adverse impact of MRSA colonization on transplantation outcome with long term use of HC.
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