title: An unexpected increase in catheter-associated bloodstream infections at a children's hospital following introduction of the Spiros closed male connector.
abstract: BACKGROUND
  Catheter-associated bloodstream infections (CA-BSIs) are associated with increased morbidity and mortality. Previous investigations have reported outbreaks of CA-BSI temporally associated with the use of needleless connector valves or similar devices.
  
  
  METHODS
  We observed an unexpected increase in the rate of CA-BSI at our institution during August 2009. We used statistical process control and quality improvement methodology to identify the factor(s) associated with this increased rate of CA-BSI.
  
  
  RESULTS
  We reviewed the overall hospital Shewhart U chart for CA-BSI, which indicated special cause variation with an unexpected cluster (6/9; 67%) of CA-BSIs localized to the oncology ward and the bone marrow transplant unit. An event-cause analysis review showed that 5 of these 9 infections were caused by Staphylococcus aureus. We discovered that the Spiros Closed Male Connector (ICU Medical, San Clemente, CA) had been introduced in these 2 units around the same time as the cluster of infections occurred. Based on this information, we discontinued the use of this device, and the CA-BSI rate and distribution of causative microorganisms returned to previous baseline values.
  
  
  CONCLUSIONS
  This case study highlights the utility of statistical process control in the surveillance and investigation of CA-BSI.
authors.affiliation: James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. Derek.wheeler@cchmc.org
authors.forename: Derek S
authors.initials: DS
authors.lastname: Wheeler
authors.forename: Maryjo
authors.initials: M
authors.lastname: Giaccone
authors.forename: Nancy
authors.initials: N
authors.lastname: Hutchinson
authors.forename: Mary
authors.initials: M
authors.lastname: Haygood
authors.forename: Kathy
authors.initials: K
authors.lastname: Demmel
authors.forename: Maria T
authors.initials: MT
authors.lastname: Britto
authors.forename: Peter A
authors.initials: PA
authors.lastname: Margolis
authors.forename: Lloyd P
authors.initials: LP
authors.lastname: Provost
mesh_terms: D016470:Bacteremia / Q000453:epidemiology*; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology*; D003627:Data Interpretation, Statistical; D004812:Epidemiologic Methods; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D013211:Staphylococcus aureus / Q000302:isolation & purification