title: Prospective study of the impact of open and closed infusion systems on rates of central venous catheter-associated bacteremia.
abstract: OBJECTIVE
  We sought to ascertain the effect of switching from an open infusion system to a closed system on rates and sequelae of central venous catheter (CVC)-associated bloodstream infection in the intensive care department (ICU) of 2 hospitals in Argentina.
  
  
  METHODS
  A prospective, controlled, time-series, cohort trial was undertaken in adult patients admitted to 4 level-III adult ICUs in Buenos Aires, Argentina, who had a CVC in place for at least 24 hours. Rates of CVC-associated bloodstream infection during a period of active surveillance with an open system (baseline; externally vented, semirigid, noncollapsible, 1-port plastic bottles) were compared with rates after switching to a closed system (intervention; nonvented, collapsible, 2-port plastic bags).
  
  
  RESULTS
  Between August 1999 and March 2002, 992 patients in the ICU with CVCs were enrolled. Patients during each study period (open system, 608; closed system, 384) were similar with respect to sex, severity-of-illness score, and prevalence of diabetes and cancer. Compliance with handwashing and CVC site care was also similar during the 2 study periods. The incidence of CVC-associated bacteremia during use of the closed system was significantly lower than during use of the open system (2.36 vs 6.52/1000 catheter-days, relative risk=0.36, 95% confidence interval=0.14-0.94, P=.02); bacteremias caused by gram-negative bacilli declined by 64%. In all, 17 patients with catheter-associated bacteremia died during the period when the open system was in use (2.8%), versus only 1 (0.2%) during use of the closed system (relative risk 0.09, P=.003). The calculated cost savings in the 20 hospital-month intervention period was $53,768 and 130.9 ICU days.
  
  
  CONCLUSIONS
  Adoption of a closed infusion system resulted in major reductions in the incidence of catheter-associated bacteremia, related mortality, and cost. Because most Latin American hospitals still use externally vented fluid containers, switching to nonvented bags could substantially reduce rates of nosocomial bacteremia.
authors.affiliation: Infection Control and Infectious Diseases Department, Bernal Medical Center and Colegiales Medical Center, Arengreen 1366, (1405) Buenos Aires, Argentina. victor_rosenthal@fibertel.com.ar
authors.forename: Victor D
authors.initials: VD
authors.lastname: Rosenthal
authors.forename: Dennis G
authors.initials: DG
authors.lastname: Maki
mesh_terms: D000368:Aged; D001118:Argentina / Q000453:epidemiology; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D002175:Candida / Q000302:isolation & purification; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007262:Infusions, Intravenous / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D007362:Intensive Care Units; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index