title: Closed-hub systems with protected connections and the reduction of risk of catheter-related bloodstream infection in pediatric patients receiving intravenous prostanoid therapy for pulmonary hypertension.
abstract: BACKGROUND
  Intravenous prostanoids (epoprostenol and treprostinil) are effective therapies for pulmonary arterial hypertension but carry a risk of catheter-related bloodstream infection (CR-BSI). Prevention of CR-BSI during long-term use of indwelling central venous catheters is important.
  
  
  OBJECTIVE
  To evaluate whether using a closed-hub system and waterproofing catheter hub connections reduces the rate of CR-BSI per 1,000 catheter-days.
  
  
  METHODS
  Single-center open observational study (January 2003-December 2008).
  
  
  METHODS
  Pediatric patients with pulmonary arterial hypertension who received intravenous prostanoids.
  
  
  METHODS
  In July 2007, CR-BSI preventive measures were implemented, including the use of a closed-hub system and the waterproofing of catheter hub connections during showering. Rates of CR-BSI before and after implementing preventive measures were compared with respect to medication administered and type of bacterial infection.
  
  
  RESULTS
  Fifty patients received intravenous prostanoid therapy for a total of 41,840 catheter-days. The rate of CR-BSI during the study period was 0.51 infections per 1,000 catheter-days for epoprostenol and 1.38 infections per 1,000 catheter-days for treprostinil, which differed significantly (P < .01). CR-BSIs caused by gram-negative pathogens occurred more frequently with treprostinil than with epoprostenol (0.91 infections per 1,000 catheter-days vs 0.08 infections per 1,000 catheter-days; P < .01). Patients treated with treprostinil after the implemented changes had a significant decrease in CR-BSI rate (1.95 infections per 1,000 catheter-days vs 0.19 infections per 1,000 catheter-days; P < .01).
  
  
  CONCLUSIONS
  The closed-hub system and the maintenance of dry catheter hub connections significantly reduced the incidence of CR-BSI (particularly infections caused by gram-negative pathogens) in patients receiving intravenous treprostinil.
authors.affiliation: University of Colorado Denver School of Medicine, The Children's Hospital, Aurora, 80045, USA. ivy.dunbar@tchden.org
authors.forename: D Dunbar
authors.initials: DD
authors.lastname: Ivy
authors.forename: Michelle
authors.initials: M
authors.lastname: Calderbank
authors.forename: Brandie D
authors.initials: BD
authors.lastname: Wagner
authors.forename: Susan
authors.initials: S
authors.lastname: Dolan
authors.forename: Ann-Christine
authors.initials: AC
authors.lastname: Nyquist
authors.forename: Michael
authors.initials: M
authors.lastname: Wade
authors.forename: William M
authors.initials: WM
authors.lastname: Nickels
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Doran
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D002408:Catheters, Indwelling / Q000382:microbiology; D011464:Epoprostenol / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D004866:Equipment Contamination; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000635:transmission; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D015994:Incidence; D007262:Infusions, Intravenous / Q000009:adverse effects; D040242:Risk Reduction Behavior
chemical_list: D000959:Antihypertensive Agents; D011464:Epoprostenol; C427248:treprostinil