title: Increased rate of catheter-related bloodstream infection associated with use of a needleless mechanical valve device at a long-term acute care hospital.
abstract: OBJECTIVE
  To determine whether introduction of a needleless mechanical valve device (NMVD) at a long-term acute care hospital was associated with an increased frequency of catheter-related bloodstream infection (BSI).
  
  
  METHODS
  For patients with a central venous catheter in place, the catheter-related BSI rate during the 24-month period before introduction of the NMVD, a period in which a needleless split-septum device (NSSD) was being used (hereafter, the NSSD period), was compared with the catheter-related BSI rate during the 24-month period after introduction of the NMVD (hereafter, the NMVD period). The microbiological characteristics of catheter-related BSIs during each period were also compared. Comparisons and calculations of relative risks (RRs) with 95% confidence intervals (CIs) were performed using chi (2) analysis.
  
  
  RESULTS
  Eighty-six catheter-related BSIs (3.86 infections per 1,000 catheter-days) occurred during the study period. The rate of catheter-related BSI during the NMVD period was significantly higher than that during the NSSD period (5.95 vs 1.79 infections per 1,000 catheter-days; RR, 3.32 [95% CI, 2.88-3.83]; P<.001). A significantly greater percentage of catheter-related BSIs during the NMVD period were caused by gram-negative organisms, compared with the percentage recorded during the NSSD period (39.5% vs 8%; P=.007). Among catheter-related BSIs due to gram-positive organisms, the percentage caused by enterococci was significantly greater during the NMVD period, compared with the NSSD period (54.8% vs 13.6%; P=.004). The catheter-related BSI rate remained high during the NMVD period despite several educational sessions regarding proper use of the NMVD.
  
  
  CONCLUSIONS
  An increased catheter-related BSI rate was temporally associated with use of a NMVD at the study hospital, despite several educational sessions regarding proper NMVD use. The current design of the NMVD may be unsafe for use in certain patient populations.
authors.affiliation: Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC 29425, USA. salgado@musc.edu
authors.forename: Cassandra D
authors.initials: CD
authors.lastname: Salgado
authors.forename: Libby
authors.initials: L
authors.lastname: Chinnes
authors.forename: Tammy H
authors.initials: TH
authors.lastname: Paczesny
authors.forename: J Robert
authors.initials: JR
authors.lastname: Cantey
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation* / Q000451:nursing; D002408:Catheters, Indwelling / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control; D004509:Education, Nursing, Continuing; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D006782:Hospitals, Special / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000592:standards*; D016602:Needlestick Injuries / Q000517:prevention & control; D009741:Nursing Staff, Hospital / Q000193:education* / Q000592:standards; D018571:Sentinel Surveillance; D013022:South Carolina / Q000453:epidemiology