Gram-negative bloodstream infections in hematopoietic stem cell transplant patients: the roles of needleless device use, bathing practices, and catheter care.
BACKGROUND
Between August 1 and October 30, 1998 (outbreak period), an increased incidence of central venous catheter (CVC)-associated gram-negative bacterial bloodstream infection (GN-BSI) was detected in hematopoietic stem cell transplantation (HSCT) candidates and recipients in an outpatient HSCT unit. The objectives of the present study were to determine strategies for controlling the outbreak and identify risk factors for GN-BSI.


METHODS
Two case-control studies, an assessment of infection control practices, microbiologic studies, and water quality analysis were conducted. A case was defined as any outpatient with a CVC and a primary GN-BSI during the outbreak period.


RESULTS
All of the 31 case patients identified had needleless intravenous (IV) access devices. Independent risk factors for CVC-associated GN-BSI were self-administered IV infusion (odds ratio [OR] = 6.2; P = .02), lower frequency of needleless device changes (OR = 15.2; P = .03), and more frequent baths (OR = 1.4; P = .05). Interventions included increased frequency of needleless device change, recommending showers rather than baths, and use of CVC protection during showering/bathing. After these interventions, the CVC-associated GN-BSI rate declined to below the preoutbreak period rate (2.1/1000 vs 0.3/1000 CVC-days; P < .01).


CONCLUSIONS
This study demonstrated an increased risk of CVC-associated GN-BSIs related to self-IV infusion, bathing habits, and frequency of needleless device change. Infection control practices associated with the use of needleless devices may expose susceptible patients to increased risk for BSI.
Toscano
Cristiana M
CM
World Health Organization, 20 Ave. Appia, Geneva, Switzerland. ctoscano@terra.com.br
Bell
Michael
M
Zukerman
Carol
C
Shelton
Will
W
Novicki
Thomas J
TJ
Nichols
W Garrett
WG
Corey
Lawrence
L
Jarvis
William R
WR
D000293:Adolescent; D000328:Adult; D000368:Aged; D001452:Balneology; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007223:Infant; D017053:Infection Control; D007262:Infusions, Intravenous / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D012648:Self Care / Q000009:adverse effects; D014481:United States / Q000453:epidemiology; D055815:Young Adult