title: Gram-negative bloodstream infections in hematopoietic stem cell transplant patients: the roles of needleless device use, bathing practices, and catheter care.
abstract: 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.
authors.affiliation: World Health Organization, 20 Ave. Appia, Geneva, Switzerland. ctoscano@terra.com.br
authors.forename: Cristiana M
authors.initials: CM
authors.lastname: Toscano
authors.forename: Michael
authors.initials: M
authors.lastname: Bell
authors.forename: Carol
authors.initials: C
authors.lastname: Zukerman
authors.forename: Will
authors.initials: W
authors.lastname: Shelton
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Novicki
authors.forename: W Garrett
authors.initials: WG
authors.lastname: Nichols
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.forename: William R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: 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